Agenda Document Pack - Midlothian Integration Joint Board - 21/12/2023
Midlothian Council · 21 December 2023
Back to Midlothian Integration Joint Board — 21 December 2023 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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Notice of Meeting and Agenda Midlothian Integration Joint Board Venue: Virtual Meeting, [Venue Address] Date: Thursday, 21 December 2023 Time: 14:00 Morag Barrow Chief Officer Contact: Further Information: This is a meeting which is open to members of the public. Page 1 of 348
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1 Welcome, Introductions and Apologies 2 Order of Business Including notice of new business submitted as urgent for consideration at the end of the meeting. 3 Declaration of Interest Members should declare any financial and non-financial interests they have in the items of business for consideration, identifying the relevant agenda item and the nature of their interest. 4 Minute of Previous Meeting 4.1 Minutes of the MIJB Meeting held on 24 August 2023 and the MIJB Special Meeting held on 21 September 2023 – for approval 5 - 26 4.2 Minutes of the MIJB Strategic Planning Group Meetings held on 28 September 2023 and 26 October 2023 – for noting 27 - 42 4.3 Minutes of the MIJB - Audit and Risk Committee Meetings held on 28 June 2023, 7 September 2023 and 23 November 2023 – for noting 43 - 64 5 Public Reports 5.1 Chair's Update, by Councillor McManus, Chair and New Members Report, report by Emma-Jane Gunda, Assistant Strategic Programme Manager, and Democratic Services 65 - 68 5.2 Chief Officers Report, report by Morag Barrow, Chief Officer 69 - 76 For Decision 5.3 MIJB Interim Chief Finance Officer Arrangements, report by Morag Barrow, Chief Officer 77 - 80 5.4 MIJB Medium-Term Financial Plan, report by David King, Interim Chief Financial Officer 81 - 88 5.5 MIJB Finance Q2 Update, report by David King, Interim Chief Financial Officer 89 - 100 5.6 Scheme of Publication Review, report by Gill Main, Integration Manager 101 - 156 For Discussion 5.7 MIJB Performance Report, report by Elouise Johnstone, Performance Manager 157 - 174 Page 2 of 348
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5.8 Public Health Prevention Update, verbal update by Jim Sherval, Public Health Consultant 5.9 Integrated Assurance Report, report by Fiona Stratton, Chief Nurse 175 - 226 5.10 Midlothian Drug & Alcohol Deaths, report by Nick Clater, Head of Adult Services 227 - 230 For Noting 5.11 Annual Alcohol and Drug Partnership Report, report by Nick Clater, Head of Adult Services 231 - 258 5.12 Community Payback Order Report, report by Nick Clater, Head of Adult Services 259 - 288 5.13 East Lothian and Midlothian Adult Public Protection Team Report, report by Nick Clater, Head of Adult Services 289 - 348 6 Private Reports No items for discussion 7 Date of Next Meeting The next meeting of the Midlothian Integration Joint Board will be held on: • Thursday, 18 January 2024, 14:00 - 16:00, MIJB Development Session • Thursday, 8 February 2024, 14:00 - 16:00, MIJB Meeting (please note that this meeting will be a hybrid meeting with attendance either in person in Midlothian Council Chambers, or via MS Teams) Clerk Name: Democratic Services Clerk Telephone: 0131 271 3160 Clerk Email: democratic.services@midlothian.gov.uk Page 3 of 348
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Midlothian Integration Joint Board Meeting Date Time Venue Midlothian Integration Joint Board Thursday 24 August 2023 2.00pm Virtual Meeting held using Microsoft Teams. Present (voting members): Connor McManus (Chair) Val de Souza Angus McCann Cllr Derek Milligan Cllr Kelly Parry Cllr Pauline Winchester Present (non-voting members): Morag Barrow (Chief Officer) Grace Chalmers (Staff side representative) Wanda Fairgrieve (Staff side representative) Claire Flanagan (Chief Finance Officer) Miriam Leighton (Third Sector) In attendance: Keith Chapman Grace Cowan (Head of Primary Care and Older Peoples Services) Nick Clater (Head of Adult & Social Care) Elouise Johnstone (Programme Manager for Performance) Saty Kaur (Chief Officer Corporate Solutions – Acting) Graham Kilpatrick (Service Manager Disabilities) Gill Main (Integration Manager, NHS) Jake Murray (Assistant Strategic Manager, NHS) Akta Nadine Jim Sherval (Public Health Practitioner, NHS) Julie Lambert (Minute taker, Business Services) Apologies: Joan Tranent (Chief Social Work Officer) Claire Gardiner (Audit Scotland) Andrew Fleming Midlothian Integration Joint Board Thursday 21 December 2023 Item No 4.1 Page 5 of 348
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2 Midlothian Integration Joint Board Thursday 24 August 2023 1. Welcome and introductions The Chair, Connor McManus, welcomed everyone to this virtual Meeting of the Midlothian Integration Joint Board (MIJB). 2. Order of Business The order of business was confirmed as outlined in the agenda that had been previously circulated. 3. Declarations of interest No declarations of interest were received. 4. Minute of previous Meetings 4.1 The Minutes of Meeting of the MIJB Board held on 22 June 2023 was submitted. It was acknowledged that there were a few spelling errors in the previous minute and some items to be rectified. Angus McCann did not receive a copy of the invitation and documents. ACTIONS: Connor will advise the amendments to the previous minute for Democratic Services to amend. Democratic Services to ensure that Angus is added to the invitation and distribution lists. 4.2 The Minutes of Meeting of the MIJB Strategic Planning Group held on 22 June 2023 were submitted and noted. 5. Public Reports Report Title/Summary Decision Action Owner Date to be Completed/Comments 5.1 Chair’s Update - Presented by Connor McManus Councillor McManus noted the Scottish Government are currently consulting on the revised statutory guidance for Strategic Commissioning Plans (SCP) and Annual Board noted the Report Page 6 of 348
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3 Midlothian Integration Joint Board Thursday 24 August 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments Performance Reports (APR). The MIJB are planning to do a submission. With the Board approval it was planned to use the Performance Assurance and Governance Group (PAGG) to review the APR guidance and strategic planning group (SPG) to review the NCP guidance to take a draft response to the SPG on 28 September, then take to the Board in October for review. The Chair encouraged Board members to attend PAGG or SPG meetings in September. Any comments to be forwarded to Cllr McManus or Gill Main. The Chair spoke about the Scottish Government meeting tomorrow and referred this to Val. Val updated the meeting tomorrow is in relation to funding challenges. The Chair of MIJB at the time had written to the Cabinet Secretary and had been in contact with Senior Civil Servants. A number of letters have been sent and a response has been received from the Cabinet Secretary and Senior Civil Servants. Morag Barrow Claire Flanagan, Cllr McManus, Val de Souza, COSLA and Scottish Government will be in attendance and MIJB members will feedback in due course. 5.2 Chief Officers Report – Presented by Morag Barrow, Chief Officer Morag presented the Chief Officer’s Report and highlighted the following: NHS Lothian are now fully funding a 20 bedded ward at Midlothian Hospital. Ongoing inspection of Integrated Care for physical Page 7 of 348
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4 Midlothian Integration Joint Board Thursday 24 August 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments disability. The inspection started in May and concludes in November. Additional funding has been secured to upgrade Primrose Lodge. This will allow the provision of additional respite accommodation for people with learning disabilities within Midlothian. Midlothian Local Development Plan – Gill and her team are leading on the 10 year plan. The two partners from Danderhall Medical Practice have retired. Newbattle Medical Practice have taken over Danderhall Practice. There have been significant improvements already in terms of access and waiting times. There are continued challenges around costs and volumes around prescribing. Morag informed today’s meeting is Claire Flanagan’s last meeting. Morag thanked Claire for everything she has achieved and wished Claire all the best in her future role. Cllr Parry raised concerns around the pressures on pharmacies regarding prescriptions and queried if there could be cross agency working. Cllr Parry has been inundated with constituent enquiries around pharmacies. Morag acknowledged these continued challenges. There have been some improvements. Morag advised they will continue to feedback to NHS Lothian but highlighted they have no control over pharmacies. Morag will take advice from the Director of Primary Care and feed back to the Page 8 of 348
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5 Midlothian Integration Joint Board Thursday 24 August 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments group. Angus asked about the partnership between Newbattle and Danderhall Practices. Morag updated Newbattle Practice were pleased to take on Danderhall practice. Newbattle are a very forward thinking practice, they have a large primary care team and work very well with the HSCP, overall Morag said this is a good move. Angus asked if they would be taking on extra GPs. Morag does not have specific details of the medical workforce however she noted there has been improved waiting times already. Morag to feedback specific details in due course. Keith asked whether additional work is required to provide the information the Care Inspectorate require. Morag replied this will involve additional demands on staff. Nick agreed this will be a lot of extra work and noted a manager has been seconded in to carry out some of the work. Val asked whether we are delivering the care or commissioning the care for Primrose Lodge. Nick advised it will be commissioned care as the clients will have complex needs. A care provider has not been identified yet. 5.3 Annual Performance Report Final Approval - Gill Main, Integration Manager Gill Main presented the Annual Performance Report 2022- 23. Members are asked to note the content of this report, Board approved Annual Performance Report Page 9 of 348
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6 Midlothian Integration Joint Board Thursday 24 August 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments approve and grant delegated authority to Morag to publish before 31 August. This date is not in line with the Scottish Government deadline which was 31 July. This is due to the Scottish Government deadlines not taking into account the publication date of the PHS validated data. Gill provided two verbal updates to the report: Page 20 of the report, following feedback added in comment about nursing home beds in Midlothian in relation to other NHS areas. This will read “fewer nursing beds than other areas”. Page 30 of report relating to premature mortality. The proportion of deaths in Midlothian in regards to substance misuse. It is proposed the wording reads “a small proportion of premature deaths in Midlothian will be related to substance misuse. In 2022 the number of deaths relating to substance misuse has reduced by 82% to the previous year. More people are known to services and are less likely to die from substance misuse.” Nick commended all the teams involved noting the staff’s commitment to helping people is second to none and do a fantastic job. Cllr Winchester agreed to go with the percentage figure and agreed staff should be commended. Keith drew attention to Page 21 of the report in relation to volunteers. Keith suggested that it could be noted that there is also benefit to volunteers as well as the benefit to people receiving support from volunteers. Gill agreed to Page 10 of 348
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7 Midlothian Integration Joint Board Thursday 24 August 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments look into this further to reinforce this message. 5.4 Finance Update - Claire Flanagan, Chief Finance Officer Claire presented the Finance Update – Quarter 1 2023/24. The report forecasts a £7.8 million overspend. Claire spoke about a significant overspend in relation to prescribing and explained the data from NHS Lothian is 3 months in arrears and a new IT system should provide updated data in September. Claire gave an overview of all overspend projections and recovery plans. In regards to the outstanding pay award, there is on-going dialogues regarding additional funding. Angus asked about the social care overspend. Claire explained the financial projections data are taken from the mosaic system which does not always reflect the reality of actual spending; this is currently being looked at. Keith raised a question around budgeting in relation to Resource Panel. Nick explained two Service Managers approve the funding on a weekly basis, one for adults and one for older people. The Learning Disabilities packages are the most expensive. Sickness levels and recruiting at Newbyres and Highbank are also being looked at. Board noted the Report Page 11 of 348
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8 Midlothian Integration Joint Board Thursday 24 August 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments Angus asked about the degree of mitigation the family provide. Claire advised there is a historic trend where there is an initial high overspend which gradually comes down but there are financial pressures. Morag highlighted there is a paper further on in the agenda pack around an initial review of the Learning Disabilities and Resource Panel. Morag spoke about the complexities of the clients at Newbyres. There is an on-going review regarding the demands at Newbyres. Morag noted that as Claire is moving on to another post, she will keep the board updated regarding appointing a new Chief Financial Officer. 5.5 IJB Performance Report - Elouise Johnstone, Performance Manager Elouise provided an overview of the IJB Performance Report. Members are asked to: • Note the performance report against the IJB Improvement Goals for 2023/24 • Approve the proposed local Improvement Goal and test of associated measures • Note the additional meeting for scrutiny of the Annual Performance Report. Board noted the Report Page 12 of 348
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9 Midlothian Integration Joint Board Thursday 24 August 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments The delay in the MSG data is an ongoing issue. Elouise spoke about the following: A and E attendances: although there has been an increase in the last 3 months, this is still below average. Unplanned admissions: this is slightly higher but there has been a downward trend over the past quarter Late discharge occupied bed days: last 3 months has shown a sustained improvement. Local Improvement Goal: update will be provided at next IJB Elouise thanked everyone who attended the APR meeting and also thanked the Performance Assurance Group members. Val commented on how much activity goes on in primary and community care. 5.6 Learning Disability Service Review - Nick Clater, Head of Adult Services Nick provided an overview of the paper. Members are asked to: • Note the contents of the Learning Disability Service Review report • Consider the recommendations outlined in the report, and • Approve recommendations within the report. The IJB agreed a review was required on all Learning Board noted the Report Page 13 of 348
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10 Midlothian Integration Joint Board Thursday 24 August 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments Disability Services within Midlothian. Carol Benington has been appointed to undertake the review. Nick spoke about the following: Eligibility criteria for Learning Disability. Overnight support needs to be reviewed. Respite service needs to be explored. Design and delivery of services needs to be looked at. External contractual services is around 85% of what is provided which also needs to be reviewed. As previously discussed, the Resource Panel need to be reviewed to monitor the spending in this area. Better forecasting is required. An improvement plan around transition work, from children’s services to adult services, is required. Aging carers are referred at crisis points therefore work needs to be done to forecast these issues. A review is required around transport spending. Angus queried the accuracy of the figures regarding learning disabilities, the data in relation to SDS and whether the mosaic system is being replaced. Nick explained the data was the best figures Carol was able to gather. Graham confirmed Mosaic is not being replaced but there are plans to upgrade the system. Graham explained the issues of the cost recording in relation to the SDS costs. Angus made the point that the report conveys the areas that generate costs rather than stating how the costs will be reduced. Nick acknowledged Angus’ concerns and gave some examples that need to be explored to reduce costs. Nick had a meeting yesterday to discuss getting some of the finances under control and getting more realistic data from Mosaic. Nick will feedback in due course. Page 14 of 348
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11 Midlothian Integration Joint Board Thursday 24 August 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments Keith commented the budget has gone from 10% of overall spend to 15% overall. Keith worries about the report conveying how costs are going to increase but less about how these costs will be controlled. Val raised the point that there are two multi-disciplinary teams; Community Learning Disability Team and the Social Work Team. Nick acknowledged this point, noting there are two different management lines and stated there is scope to look at this in the future. 5.7 Public Health Recommendations for Midlothian IJB in response to Director Of Public Health Report Jim Sherval, Public Health Consultant Jim provided an overview of the report noting the key recommendation, 2.1 in the report, employability and employment support for local people in health and social care employment. Angus asked if they are at a stage whereby they are able to determine the specific actions needed. Jim said they have a number of ideas but are not at a stage of presenting an action plan. Val suggested partnership working with people who have direct responsibility for employability, e.g. skillnet. Jim agreed. Cllr Parry has noted she is happy to help. Board noted the Report Page 15 of 348
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12 Midlothian Integration Joint Board Thursday 24 August 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments 5.8 IJB Self Development Plan - Duncan Stainbank, Chief Internal Auditor Due to technical issues Duncan was unable to join the meeting. Any questions to be raised with Duncan offline. Board noted the Report 5.9 IJB Performance Framework - Elouise Johnstone, Performance Manager Elouise had already left the meeting and advised the report was for noting and she is happy to take any questions by email. Board noted the Report 5.10 Governance Position Overview - Gill Main, Integration Manager Gill noted three key areas for review: • Records Management Plan • Scheme of Publication • Risk Register Policy Gill stated the report is for noting and is happy to take any questions. Board noted the Report 5.11 Strategic Commissioning Plan 2025-28 Development Timeline - Gill Main, Integration Manager Board noted the Report Page 16 of 348
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13 Midlothian Integration Joint Board Thursday 24 August 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments Gill anticipates there will be a paper presented to MIJB in the first part of 2024. 6. Private Reports No items for discussion 7. Any other business No additional business had been notified to the Chair in advance. Chair gave a special mention to Claire. Chair thanked Claire for the time she has given to the MIJB partnership and everyone wished Claire all the best in her new position. 8. Date of next meeting The next meetings of the Midlothian Integration Joint Board would be held on: • Thursday 12 October at 2pm (Action: All Members to Note) The meeting terminated at 3.30 pm. Page 17 of 348
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Midlothian Integration Joint Board Meeting Date Time Venue Special Midlothian Integration Joint Board Thursday 21 September 2023 2.00pm Virtual Meeting held using Microsoft Teams. Present (voting members): Councillor McManus (Chair) Val de Souza (Vice Chair) Councillor Winchester Councillor Parry Andrew Fleming (NHS Lothian) Angus McCann (NHS Lothian) Councillor Alexander (proxy representative) Present (non-voting members): Morag Barrow (Chief Officer) Grace Chalmers (Partnership Representative (MLC)) Keith Chapman (User Representative) Claire Flanagan (Chief Finance Officer) Wanda Fairgrieve (Partnership Representative (NHS)) Jordan Miller (Partnership Representative (NHS)) In attendance: Grace Cowan (Head of Primary Care and Older Peoples Services) Gill Main (Integration Manager, NHS) Elouise Johnstone (Programme Manager for Performance) Saty Kaur (Chief Officer Corporate Solutions (Acting)) Claire Gardiner (External Audit) Patricia Fraser (External Audit) Gary Leadbetter (Democratic Services Officer) Apologies: Midlothian Integration Joint Board Thursday 21 December 2023 Item No 4.1 Page 19 of 348
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2 Midlothian Integration Joint Board Thursday, 21 September 2023 1. Welcome and introductions The Chair, Connor McManus, welcomed everyone to this virtual Special Meeting of the Midlothian Integration Joint Board. 2. Order of Business The Order of Business was confirmed as outlined in the agenda that had been previously circulated. 3. Declarations of interest No declarations of interest were received. 4. Public Reports Report Title/Summary Decision Action Owner Date to be Completed/Comments 4.1 Chair’s Update – Councillor McManus (verbal) Councillor McManus, the Chair, noted that he had attended a meeting for all of the Chairs and Vice-Chairs in Scotland with attendance from Maree Todd (Scottish Government). The Chair stated that they had useful conversations about the National Care Service and how this is coming together and Stage One part of the Bill which is due for the end of January 2024. The Chair noted he now had a contact that is the Depute Leader in the creation of the Bill, who is also looking to take questions and comments. The Chair stated that, with the Board’s approval, he might request that they hold a session with the MIJB members to allow questions to be asked on what the National Care Service would mean for Midlothian. Board noted the Chair’s update. Board confirmed that they welcomed a session from the Chair’s contact – Chair noted that he would let the Board know about dates, etc. in due course. Councillor McManus, The Chair. Page 20 of 348
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3 Midlothian Integration Joint Board Thursday, 21 September 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments 4.2 Chief Officer’s Update – Morag Barrow (verbal) Morag Barrow, Chief Officer, explained that there is a new Covid variant which is much more virulent in terms of community transmission, although noted that there are no serious impacts that have been realised. Noted that there is more general transmission in the community. Morag noted that, in terms of mitigation, the annual vaccination programme is in place which has commenced across Midlothian. Morag noted that the Scottish Government have requested that the programme be brought forward, in light of the new variant, which is currently being worked on. Morag also noted the national data coming out around 2022 drug and alcohol deaths. Morag noted that the figures in Midlothian were 4 for the former and 17 for the latter, a reduction from 19 and 18 respectively for 2021. Morag noted that a paper/presentation would be brought to the Board at a future meeting detailing the work underway in this sphere. The Chair thanked Morag for her update and opened it up to questions. In response to a question raised by Keith Chapman about mitigations or reporting in respect of power balances, in light of recent media reports about surgeons sexually abusing junior staff, Morag noted that they had not yet received a position from NHS Lothian. Morag expressed confidence that the matter is being considered. Morag then spoke to the upcoming national speak up week and the Board noted the Chief Officer’s update. Morag Barrow, Chief Officer, to provide further insight into NHS Lothian position and work being done in respect of power balances (and potential abuse thereof) between senior and junior staff. Morag Barrow, Chief Officer, to enquire about current Covid case figures. Morag Barrow, Chief Officer. Morag Barrow, Chief Officer. Page 21 of 348
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4 Midlothian Integration Joint Board Thursday, 21 September 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments work being done around this. Morag noted they was happy to return with a central NHS Lothian position on the matter. Angus McCann queried if there were any current Covid figures, to help understand the scale of cases now versus the previous winter. Morag explained that these figures were not currently routinely shared but offered to enquire. Andrew Fleming raised a question on the preparedness for winter. Morag noted that this would be addressed within the assurance report for the October MIJB. Morag provided assurance that that there had been planning and work around readiness for winter which has been happening since summer. Morag also spoke to risks and challenges around care home bed capacity. 4.3 MIJB Annual Accounts Claire Flanagan, Chief Financial Officer, noted that the Annual Accounts and External Audit Report had not been submitted and provided apologies. They explained that the delay was due to both resourcing issues with Audit Scotland and some uncertainties within the Annual Accounts that still needed to be worked through. Claire Gardiner explained that the resourcing delays were sector-wide and not specific to MIJB. They noted that the auditors have a duty of care to ensure the Accounts are materially correct and emphasised that they wanted to take the appropriate time to work through the uncertainties. Claire G stated that they are endeavouring to conclude as soon as possible. Page 22 of 348
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5 Midlothian Integration Joint Board Thursday, 21 September 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments 4.4 MIJB Directions Half Year 2023/24 Report Elouise Johnstone, Programme Manager for Performance, presented the MIJB Directions Half Year 2023/24 Report. The purpose of this report is to update the IJB on the half- year status of progress towards the Midlothian IJB Directions issued for 2023/24. IJBs, Health Boards and Local Authorities have a legal obligation to both issue and monitor the effectiveness of Directions as described in the Public Bodies (Joint Working) (Scotland) Act 2014. Directions are how the IJB action their strategic plan to achieve their aims. Midlothian IJB Directions for 2023-24 were issued to the Chief Executives of Midlothian Council and NHS Lothian on the 31 March 2023. Members are asked to: • Note the level of assurance provided against the process measures (Appendix 1). The Chair thanked Elouise for the Report and opened it up to questions. Angus McCann asked Elouise to comment on July 2023 figures and the progress in completing them, with reference to constraints, noting that there was still some way to go. On January 2024 figures, Angus further queried the Board noted the level of assurance provided against the process measures in the MIJB Directions Half Year 2023/24 Report. Page 23 of 348
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6 Midlothian Integration Joint Board Thursday, 21 September 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments progress towards these given that the figures were not yet presented. In relation to the latter question, Elouise explained that the nature of measurement of key activities is that they are scheduled at regular intervals and reporting to the Directions is tied to this and so some of this information does not yet exist. In relation to a further question from Angus on scrutiny of progress towards these figures, Elouise explained the figures are discussed in a number of forums and that there will be a clear picture in December, allowing corrective actions to be taken. Morag Barrow, Chief Officer, answering the former question explained that tough targets were set and perhaps not appropriate and that there was learning here going forward. Morag further provided background context to the matter and noted, that there was still strong progress and performance. Angus noted that it would be helpful to have context within the report going forward. Andrew Fleming queried how some of the measurements were being made, in terms of the marking frame and approach. Elouise explained that it is a thorough audit, by the performance team, of the documentation agreed as the source for the information. In relation to a question from Keith Chapman on the set aside budget and engagement at whole system level and a report in respect of this, Gill Main, Integration Manager, noted that there are multi-dimensional challenges to this Page 24 of 348
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7 Midlothian Integration Joint Board Thursday, 21 September 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments work. As such, Gill explained that this work is going to take a while, including in terms of providing a comprehensive report to the MIJB on this. Val de Souza queried how things are doing in comparison to other parts of Lothian. Elouise explained that, in relation to Directions this is difficult to measure, although there are opportunities to understand this in terms of Strategic Aims. Morag noted that, as part of quarterly meetings with the Chief and Depute Executives of NHS Lothian, which cover performance and there is interest in lifting some of the work being done in Midlothian to determine how this translates in other areas. Gill also spoke to some of the sector-leading work ongoing and planned and external interest towards it. 5. Private Reports No items for discussion. 6. Any Other Business No additional business had been notified to the Chair in advance. 8. Date of next meeting The next meeting of the Midlothian Integration Joint Board will be held on: • Thursday, 12 October 2023 at 14:00 Page 25 of 348
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8 Midlothian Integration Joint Board Thursday, 21 September 2023 (Action: All Members to Note) The meeting terminated at 3.30 pm. Page 26 of 348
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Midlothian Integration Joint Board Meeting Date Time Venue Strategic Planning Group Thursday 28 September 2023 14:00 – 16:00 Virtual Meeting held using MS Teams. Chair: Gill Main (Integration Manager) Vice Chair: Vacant Present (MIJB members): Nick Clater (Head of Adult Services) Cllr Pauline Winchester Claire Ross (Chief AHP) Grace Cowan (Head of Older People & Primary Care) Present (HSCP): Emma-Jane Gunda (Assistant Strategic Programme Manager) Kevin Dickson (Programme Manager) Elouise Johnstone (Programme Manager) Chris King (Finance) Rachael Honeyman (Head of Volunteering) Fiona Kennedy (Group Service Manager) Rebecca Green (Clinical Director) In attendance: Keith Chapman Jim Sherval (Public Health) Laura Hill Andrew Fleming Rebecca Miller (part meeting) Strategic Planning Group Thursday, 21 December 2023 Item 4.2 Page 27 of 348
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2 Strategic Planning Group Thursday 28 September 2023 Apologies: Morag Barrow Fiona Stratton James Hill Laura Hutchison Annette Lang Laura Douglas Val de Souza Marlene Gill Angus McCann Joan Tranent 1. Welcome and introductions Gill Main (Chair) welcomed everyone to the meeting and introduced Claire Ross, the new Chief AHP to the group. 2. Order of Business The order of business was as set out in the agenda. 3. Minutes of Meeting The Minutes of Meeting of the Strategic Planning Group held on 6 July 2023 were reviewed and approved. Page 28 of 348
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3 Strategic Planning Group Thursday 28 September 2023 4. Public Reports Report Title/Summary Decision Action Owner Date to be Completed/Comments 4.1 Chairs Update GM advised the group on the Scottish Government consultation on revised guidance for Annual Performance Reports (APRs) and Strategic Commissioning Plan. This consultation closes at the end of the month and new statutory guidance is expected in early 2024. GM mentioned the ongoing inspection of the Physical Disabilities service and initial feedback form the care inspectorate. GM suggested that the group should consider the opportunities to improve links between our strategic and operational governance. GM advised Planning, Performance and Programme had recently met with Audit Scotland to review the IJBs strategic Governance, and by association, some of the assurances from the HSCP in relation to strategic alignment and evaluation. GM fed back how impressed they are by some of the work done by services over the last year. GM thanked the group for their support. GM advised the IJB Board scheduled for 12 October has been cancelled as an audited set of accounts has not been achieved in time. GM noted the review of IJB governance in 2023 and advised of the identified requirement the TOR for this group to be reviewed and refreshed in 2024. 4.2 Finance and Performance Update – Chris King CK advised that the Finance and Performance meeting had recently had to take a more Finance heavy focus to address the financial challenges we are facing, and the financial recovery plans being approved by the IJB. CK noted the ambition to address the balance between ‘Finance’ and ‘Performance’ in this meeting, and F&P will now Page 29 of 348
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4 Strategic Planning Group Thursday 28 September 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments revert to its original structure with a quarterly focus on recovery plans. CK noted the session I December dedicated to the review of service plans 4.3 PAGG update – Elouise Johnstone EJ noted the recent work of the PAGG group in supporting the scrutiny of data in relation to the APR and the SG consultation on APR guidance. 4.4. Workforce Governance Group update – Kevin Dickson KD updated that the Workforce Governance Board and both sub-groups have now met with the Board having begun to assign and delegate workstreams. Work is progressing on the 2022-25 plan, updating the year 1 position and adaptations to the actions or year 2, and a scoping exercise on the HSPCs readiness for the enactment of the Heath and Care (Staffing) (Scotland) act in 2024. KD also advised Speak Up Week is taking place between 2nd to 6th October and information will be released via Twitter and other social media platforms. 5. Reports 5.1 Topic in Focus Set-Aside Financial Update: 2023/24 Q1 Position Discussion Presentation from Graeme McGuire, Finance Manager GMc provided an overview of the slides and the Q1 position. Page 30 of 348
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5 Strategic Planning Group Thursday 28 September 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments GM asked what this group could support to maximise opportunities and to better understand the set aside budget and how we take the next steps. KC queried, that if historically no area has been able to achieve a 3% saving, whether it was even a possibility. GMc confirmed previously savings have been made of 1- 2% whilst other areas have achieved 3%. GMc said he is confident that savings can be made through the help of the Financial Improvement Group which the Chief Executive sits on. GMc said savings could be made through making difficult choices. EJ advised she is interested in the planning assumptions in Edinburgh and Midlothian and commented that our data on Tableau is no higher in Midlothian for the ED attendance rate prior to Covid. EJ advised we are static and not contributing to demand. GMc confirmed that Acuity levels are increasing with sicker patients presenting. GMc advised that there has always been demand and we need a more substantive workforce including increasing nursing levels. CK advised it is a complex system which is taking time to work through. GM reminded the group that one of the Directions for 2023/24 was to improve the understanding of the set aside position by considering and designing and approach and mechanisms to do so. The first step in this was to ensure there was better communication and understanding of the set aside position through the regular updates provided by GMc, but there was now a requirement to move into that second phase of activity to begin to understand the current assumption that sat underneath the financial planning through a short life working group to look at assumptions. CK, GM and EK to discuss offline and consider the plan for further review at this group. GM/CK 25/01/2024 5.2 Items for Decision Review of Data to support Midlothian Local Development Plan 2 Paper presented by Elouise Johnstone, Strategic Programme Manager for Performance EJ provided an overview of the paper, asking the group to note the data and population projections, then consider if the section complied from service responses Page 31 of 348
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6 Strategic Planning Group Thursday 28 September 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments was an accurate representation of the service position. EJ asked the group to consider if there are any further areas to include to pass evidence to the Midlothian Council Planning team for inclusion within the plan. EJ advised the evidence statement includes some predictions and assumptions of the general health and wellbeing of families in Midlothian as the picture is likely to be shifting considerably. AF commented that a lot of focus was on the revenue costs with the addition of primary care facilities etc. GM advised that we do not know the history of developer contributions or the historic planning process success rate for ensure these were realised. EL commented that there is a historic challenge of developer costs and where the money is spent. AF asked what could happen if Midlothian Council brought in policy changes. GM advised that Grant and Alison will be taking this forward and will be submitting the Local Development Plan to Scottish government for review in January 2024, after which we will have more information. RG advised that the two biggest pressure points are South Bonnyrigg and Rosewell with Roslin having also grown by 40% in the last 5 years. Loanhead will also grow, and RG thinks we will require two premises to support that area. GM noted that there were some gaps from the information required from the Operational business Team. GC commented that NHS Lothian Capital Planning are in communication with Midlothian Council who are looking at the cost of generating new properties to forecast the infrastructure costs and gave assurance that this information was being shared. GM asked the group if they were in agreement to share the collated information with spatial planning colleagues in Midlothian Council. The group agreed with no objections. EJ to review the report within the paper regarding Straiton, Loanhead and St Margaret’s in Roslin and update the population data. GM will share the report with Spatial Planning colleagues at Midlothian Council. EJ GM 04/10/2023 13/10/2023 Page 32 of 348
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7 Strategic Planning Group Thursday 28 September 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments 5.3 Review of Draft Midlothian IJB Response to the Scottish Government consultation on Strategic Commissioning Plan / Annual Performance Report Statutory Guidance Paper presented by Emma-Jane Gunda, Assistant Strategic Programme Manager EJG provided an overview of the draft response and fed back comments. EJG asked the group to review the draft document and consider any amendments required and agree to put forward as recommendations to the group. KC said he thought it was a very big document and if people are to engage it would need to be more readable and the dictated structure is a barrier to that. GM facilitated a review of the draft documents. A number of additional comments for inclusion were suggested. GM asked the group if, subject to amendments, they were in agreement to recommend the draft consultation responses to the Board for approval. The group agreed with no objections. 5.4 Items for Discussion Strategic Directions Mid-Year Review Paper presented by Elouise Johnstone, Strategic Programme Manager for Performance EJ summarised the paper which is a 6-month update to ensure adequate progress is being made on our Directions with the full report due on 15 February 2024. EJ advised some Directions apply to all services and some apply to appropriate services. EJ asked the group to note the level of assurance and note and examine the variations and asked if any corrections were required. AF asked what the financial position was. EJ confirmed this is 100%. AF said this is helpful to manage expectations. Draft responses approved GM to share with Chief Officer, IJB Chair and Vice Chair for approval in light of October Board being cancelled. GM 13/10/2023 Page 33 of 348
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8 Strategic Planning Group Thursday 28 September 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments GM asked if anyone had any questions or comments before this closes. The group confirmed they did not. 5.5 Items for Noting Operational Assurance re. Service Planning Paper from Morag Barrow, Chief Officer Morag Barrow was not in attendance at today’s meeting however the Chair, Gill Main, provided an overview. GM advised the paper is to give assurance to the IJB Board that SMT have revied service planning and provided assurance on the operational integrity and validity of the service planning process, to note the intention to develop a HSCP delivery plan for 2024/25, and for Planning, Performance and Programme to support a short programme of learning for service managers embarking on the revision of service plans for 2024/25. 6. Any other business Report Title/Summary Decision Action Owner Date to be Completed/Comments None raised. 7. Date of next meeting The next meeting of the Strategic Planning Group will be held on 30 November at 2.00pm. Please note this meeting is currently planned to be a virtual meeting using MS Teams. Actions: All Members please note and progress the actions detailed in this document Page 34 of 348
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Midlothian Integration Joint Board Meeting Date Time Venue Strategic Planning Group Thursday 26 October 2023 14:00 – 16:00 Virtual Meeting held using MS Teams. Chair: Gill Main (Integration Manager) Vice Chair: Vacant Present (MIJB members): Keith Chapman Present (SPG Members): Rachael Honeyman (Head of Volunteering, NHS Lothian) Wanda Fairgrieve (Partnership Representative) Rebecca Miller (Head of Strategy Development, NHS Lothian) In attendance: Jim Sherval (Public Health, NHS Lothian) Jake Murray (Project Team Manager, Midlothian HSCP) Kate Thornton (Equality & Human Rights Lead, Midlothian HSCP) Ruth Tolton (Project Manager, Midlothian HSCP) Kevin Dickson (Programme Manager, Midlothian HSCP) Elouise Johnstone (Programme Manager, Midlothian HSCP) Emma-Jane Gunda (Assistant Strategic Programme Manager, Midlothian HSCP) Strategic Planning Group Thursday, 21 December 2023 Item 4.2 Page 35 of 348
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2 Strategic Planning Group Thursday 26 October 2023 Apologies: Morag Barrow Nick Clater Rebecca Green James Hill Laura Hill Laura Hutchinson Fiona Kennedy Chris King Annette Lang Fiona Stratton Joan Tranent Pauline Winchester Saty Kaur 1. Welcome and introductions GM welcomed everyone to the meeting and introduced KT and RM to the group. 2. Order of Business The order of business was as set out in the agenda. 3. Minutes of Meeting ad Action Log The Minutes of Meeting of the Strategic Planning Group held on 28 September 2023 were reviewed and approved. EJ shared the action log, reviewed, and updated the actions to date. Page 36 of 348
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3 Strategic Planning Group Thursday 26 October 2023 4. Public Reports Report Title/Summary Decision Action Owner Date to be Completed/Comments 4.1 Chairs Update GM thanked the group for their recent work on producing an evidence statement to support Midlothian Council spatial planners to write the Midlothian Local Development Plan 2. GM advised the group that following the last SPG, the Midlothian IJB scheduled to take place in October had been cancelled. GM noted this had meant that the responses prepared by SPG for the SG consultations on revised statutory guidance on ‘Strategic Planning’ and Annual Performance Reports had been approved by Chair and Vice Chair via email and then submitted within the consultation time frame. GM discussed the continued ambition from the Board to recognise the key role of Community Planning and how we ensure quality community engagement and participation. As part of this ambition, SPG will be participating in two activities over the coming months: Completing a self-evaluation using the HIS Quality Framework for Community Engagement, and supporting a review of the Terms of Reference for this group. 4.2 Finance and Performance Update – Elouise Johnstone EJ provided a verbal update on behalf of CK. EJ fed back the NHS financial position looks slightly improved on what was predicted initially with the recognition that there are still significant financial implications across the system. 4.3 PAGG update – Elouise Johnstone EJ provided a verbal update on the Performance and Assurance Group and work to design local measures to compliment National indicators. This work started by considering which data sets can support a better and more detailed local position in Page 37 of 348
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4 Strategic Planning Group Thursday 26 October 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments relation to Health and Equalities. EJ discussed the collaborative and co-designed process with P3, LIST, and input from operational and Head of Service. KC asked if anyone else is looking into similar approach. EJ confirmed Midlothian continue to find creative solution to local data reporting alongside our LIST colleagues who are not aware of similar work elsewhere. 4.4. Workforce Governance Group update – Kevin Dickson KD advised work is continuing on the annual review of the 3-year Workforce plan within the Workforce SubGroup including a review of outcomes and measures. This updated workforce plan will be reviewed by the Integrated Workforce Governance Board on 28 November. KD advised there has been KD noted the work within the Workforce Engagement SubGroup to better understand the iMatter results to identify areas required for training, retaining staff, and improve recruitment. 5. Reports 5.1 Topic in Focus HIS Quality Framework for Community Engagement Self-Evaluation & Action Planning - Kate Thornback, Equality and Human Rights Lead KT provided an overview of the HIS Quality Framework for Community Engagement, and outlined the work required to complete a self-evaluation. The group were then split into two breakout rooms for discission on the challenges and opportunities to consider when undertaking this work. The groups feedback their discussion and themes were ways of working to improve engagement at organisational level, involving and engaging with people who are the most impacted, the fundamental principles for engagement and how there are some Page 38 of 348
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5 Strategic Planning Group Thursday 26 October 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments challenges which need considered due to the complexity of relationships between the IJB and local authorities and other groups. The group recognised the difference between representation and engagement and the importance of having a wide range of community representation. GM asked the group to consider the strengths and opportunities to improve Board community engagement. KC said ensuring earlier participation in plans are important and not just commenting on a plan that was already produced. EJ discussed the Board 2023/24 Direction relating to services gathering and using feedback in redesign. RM was keen to ensure joined up consultation with NHS Lothian and would discuss at NHS CMT. GM thanks KT for the presentation and asked the group how they would like to take this forward the commission from the IJB to complete a self-evaluation and action plan for improvement. The group agreed to use the next Planning and Transformation SPG session on 23 November to consider the action required and leads to help design and implement the action required. KT to lead on inviting a small group to plan and deliver this work KT April 2024 5.2 Items for Decision MIJB Commission: Scoping Exercise in relation to Local Employability and other Fair Work for Pay Options – Jim Sherval, Public Health Consultant JS provided an overview of the paper regarding employment in Midlothian and the challenges the HSCP face regarding recruitment legislative duties. JS made reference to point 3.16 within the paper which states the IJB is not an employer and reiterated the importance of ensuring that both employing partners were involved in considering the opportunities for change. GM noted the IJB commission for the Strategic Planning Group alongside with Midlothian Health and Social Care Partnership Workforce Governance Board to complete a scoping exercise including all key stakeholders to establish the current landscape in relation to employability and employment support for local people Page 39 of 348
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6 Strategic Planning Group Thursday 26 October 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments entering health and social care employment, including the identification of opportunities for improvement. GM thanked JS for the report and opened up for group discussion. The group noted the importance of ensuring a strategic approach with partners to ensure the recommendation to the Board are integrated health and social solutions, but recognising that NHS Lothian and MLC are the employing partners. GM suggested it was important for this group to consider • Synchronicity across health and social care • The best approach to understanding the strategic landscape, identify what could be even better and identify any barriers that might require IJB support to achieve that ‘even better’ through this group • Where operational spaces could consider what the practical ‘do now’ things might be via the Workforce Engagement SubGroup KD expressed concern that there have been persistent gaps across Lothian since 2015 in certain areas including OHT, Mental Health nursing, Care at Home Services and stability within Adult social care. KC commented there are barriers for skilled jobs and people need to be aware they are candidates for jobs. RH commented there are volunteering apps and employability pathways and is excited to see what this will look like going forward. SK, although had given apologies, had indicated interest in this work via email. The group agreed to taking the work forward in two ways; one via the HSCP integrated Workforce Governance Board regarding operational actions, and one to investigate future strategic changes 1. To commission a small task and finish group from within SPG to consider and present back to the Board strategic actions and/or identify the opportunities for positive and enabling change. 2. JS/KD to take a paper to HSCP Integrated Workforce Governance Board to consider and recommend for action some immediate pieces of work to be delivered by the Workforce Engagement SubGroup specific operational action. Task and Finish group to be set up, meet, and establish areas of priority for discussion Paper to come to Workforce Governance Board in November KD/JS KD/JS December 2023 November 28th 2023 Page 40 of 348
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7 Strategic Planning Group Thursday 26 October 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments 5.4 Items for Discussion Scottish Government’s Women’s Health Plan – Rebecca Miller, Head of Strategy Development RM provided an overview of the paper and confirmed Dona Milne (DM) is the Executive Lead for this work. RM advised there is a short life working group to develop a high-level action plan and a scoping exercise is being undertaken to discuss where we are at, what the challenges are and what we would like to do. RM confirmed there is no additional money for the delivery of the Women’s Health Plan and actions are dependent on the create use of existing resources. RM will be taking this to the Strategy Planning and Performance Committee next month to discuss the next steps. RM asked the group to note the work that has been done to date and also asked for any comments or changes as she continues to develop the plan. RM hopes to have a final plan that she can share in early 2024. GM thanked RM for the presentation and opened up for group discussion. EJ suggested it would be useful to look at the data and how women look at unscheduled care and the protected characteristics and offered to meet and review. EJ suggested it might also be useful to include Wendy Reid (WR). RM was keen to take up this offer. KC mentioned there is no mention of education within the plan, RM confirmed this is covered within the Scottish Government plan and stated work is already underway as Public Health are working with education on this however, she could make reference to this within the plan. KC also commented on the recent staff culture challenges that have been reported with in some medical professionals towards female colleagues and asked what was being done about this. RM confirmed women are underrepresented in some areas and there is more work to be done on EJ, WR and RM to meet to discuss protected characteristics and data. EJ January 2023 Page 41 of 348
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8 Strategic Planning Group Thursday 26 October 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments which areas are underrepresented and why this is. Colleagues also need to be reminded of our NHS values and working within them. KC said we need robust measures in place, and we need to mitigate against issues around women not being able to speak up for fear of ruining their careers. GM asked if RM had further request from the Group. RM was keen to explore some work relating to data and inequalities as offered by EJ. 6. Any other business Report Title/Summary Decision Action Owner Date to be Completed/Comments None raised. GM thanked the group for their time and contributions and closed the meeting 7. Date of next meeting The next meeting of the Strategic Planning Group will be held on 30 November at 2.00pm. Please note this meeting is currently planned to be a virtual meeting using MS Teams. Actions: All Members please note and progress the actions detailed in this document Page 42 of 348
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Midlothian Integration Joint Board Meeting Date Time Venue Audit and Risk Committee Wednesday 28 June 2023 2.00pm Virtual Meeting held using MS Teams. Present (voting members): Cllr Connor McManus (Chair) Angus McCann Andrew Fleming Present (non-voting members): Morag Barrow (Chief Officer) Claire Flanagan (Chief Finance Officer) Derek Oliver (Chief Officer Place) Duncan Stainbank (Chief Internal Auditor) In attendance: Patricia Fraser (Audit Scotland, External Auditor) Claire Gardiner (Audit Scotland, External Auditor) Janet Ritchie (Democratic Services Officer) Apologies: MIJB Audit and Risk Committee Thursday 7 September 2023 Item No 4.1 Page 43 of 348
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2 Audit and Risk Committee Wednesday 28 June 2023 1. Welcome and Introductions The Chair welcomed everyone to the meeting Order of Business was as detailed in the agenda. 2. Order of Business The Order of Business was as detailed in the agenda. 3. Declarations of interest No declarations of interest were received. 4. Minutes of Meeting 4.1 The Minutes of Meeting of the Audit and Risk Committee held on 01 December 2022 was submitted and approved as a correct record. 4.2 Matters Arising: None 5. Public Reports 5.1 Midlothian Integration Joint Board Annual Audit Plan 2022/23 Claire Gardiner advised that she has recently taken over the audit from Gillian Woolman following her retirement and introduced the Annual Audit Plan 2022/23 advising this was the first plan following appointment and provided the Board with an outline of the sections contained within the Plan. The Chair, Cllr McManus commented positively on the report and opened it up for questions. Mr McCann raised a question with regards to the timetable and at the start it was noted that we are a bit behind and asked for an update on meeting the timetable. Page 44 of 348
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3 Audit and Risk Committee Wednesday 28 June 2023 Ms Flanagan responded advising that they were hoping to stick to the timetable and will work closely with the Audit Team to ensure they meet those time scales. Ms Flanagan further advised that even although over the last few years during the pandemic the deadlines were extended the still met the September deadline so they were positive they would continue to meet the deadlines. Action: The Midlothian integration Joint Board, Audit and Risk noted the Report. 5.2 Midlothian Integration Joint Board Internal Audit Annual Assurance Report 2022/23 The purpose of this report is to present the Internal Audit Annual Assurance Report 2022/23 for the Midlothian Health and Social Care Integration Joint Board (MIJB) which includes the Chief Internal Auditor’s independent assurance opinion on the adequacy of MIJB's overall control environment for the year ended 31 March 2023 Duncan Stainbank, Chief Internal Auditor introduced this report and advised that the Internal Audit Annual Assurance Report 2022/23 was Appendix 1 to the report and the Partners’ Internal Audit Assurance 2022/23 Appendix 2 to the report. Mr Stainbank further highlighted some of the main sections contained within these reports. The Chair thanked Mr Stainbank for the report and opened it up for questions. Mr McCann commented on ‘P30, 2.6 - Further improvements in governance, risk management and internal control’ and asked for some further feedback on this and the implementation of the previous internal audit recommendations. Mr Stainbank in responding confirmed that a report would be brought back to the next committee on the details of those. Mr McCann asked a further question in relation to Recommendation 2 (The Medium-term Financial Plan should be developed to include a more explicit link to the Midlothian IJB Strategic plan and its priorities for the years ahead) and while he does agree with this, he asked how we propose to develop this. Mr Stainbank advised that further work is required going forward linking into the Strategic plan and advised that Ms Flanagan could perhaps give more details on how that will happen in terms of the strategic plan linkage. Ms Flanagan advised that in the last report the audit recommendation was to make more of a link between the MIJB financial plan and its Strategic plan and highlighted this was a substantial piece of work and outlined some of the challenges and that the risk was that the finances may potentially hinder the implementation of the MIJB Strategic plan. Page 45 of 348
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4 Audit and Risk Committee Wednesday 28 June 2023 Further comments were made on the challenges in linking these two 3-year plans and would have been ideal if this had happened at the start of the new Strategic plan and they would look at getting a work around position to get the MJIB Financial plan more aligned to the currently approved Strategic plan. Chief Officer, Morag Barrow highlighted on P37 under each Recommendation in the column ‘Responsibility and timescale’ can we add in the title who is responsible - CFO. Ms Barrow commented on the recommendation which was scored down as there is no certainty on the budget and they can develop that longer term plan, but it is on the assumption that the full allocations are passed over and this year for example the planning was based on that and at the last minute we didn’t get it all so there can be certain things that are out with our control. The Chair commented everyone would agree that this year was an example when things didn’t go particularly right and it’s about building that resilience into the plans in the future to ensure we have future financial sustainability. Mr Fleming raised a question with regards to 4.2.4 where it notes an incremental approach to service change continues to be taken and it flags up the risk of potential disintegration and how we are going to address this with the challenges we must face. In responding Ms Flanagan advised that open and transparent dialogue around some of the challenges in financial settlements need to take place at an early stage and highlighted the struggle this year in balancing the budget following the decision made in June. Mr Stainbank also provided an explanation on the timing of the audit and that ordinarily there would have been recommendations 1 and 2 and recommendations 3 and 4 probably would not have been there if the audit had been done earlier in the year. The requirement for the recovery plans had come in at a later date during and when the audit work was completed. The Chair commented on the importance of thinking about next budget now and it was a priority that Morag was very much involved in conversations and that we are clear on where we are and that there are no surprises. Further discussion took place with regards both parties working to together to manage the uncertainties that each are facing, the Strategic plan and the projects planned and the importance of early discussion in going forward. Action: The Midlothian integration Joint Board, Audit and Risk noted the Report 5.3 Midlothian Integration Joint Board Draft Unaudited Annual Accounts 2022/23 The Chief Finance Officer presented the draft Unaudited Annual Accounts 2022/23 for the Board to agree to be published and presented to Audit Scotland. The Chief Finance Officer then provided an overview of the main points contained within the report highlighting The Management Commentary, The Annual Governance Statement and the Financial Position. Page 46 of 348
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5 Audit and Risk Committee Wednesday 28 June 2023 Thereafter Mr McCann, thanked the Chief Finance Officer for the report and agreed to the publication. He further commented on P52 of the pack, under ‘IJBs Visions and Objectives’ - The IJB’s vision and objections are laid out in the IJB’s Integration Scheme, advising he didn’t think this was in the integration scheme but thought in the Strategic plan. Ms Flanagan advised that perhaps vision objectives was not the right word and commented that there is a component of the vision of integration laid out within the Integration Scheme and then more specifically to Midlothian it is within the Strategic Plan. Action: It was agreed subject to the change discussed with regards to the Vision and Objectives the draft Unaudited Annual Accounts 20233/23 were approved. 5.4 Midlothian Integration Joint Board Risk Register Q3 and Q4 The Integrated Joint Board (IJB) Audit and Risk Committee maintains a strategic risk profile which is regularly scrutinised. However, it is important that Midlothian IJB is kept informed of its key risks and the actions undertaken to manage these risks. This report contains the strategic risk profile covering Quarter 3 2022/23, 1st October 2022 – 31st December 2022 and Quarter 4 2022/23, 1st January 2023 – 31st March 2023. Chief Officer, Place Derek Oliver presented the Strategic Risk profiles for Quarter 3 and Quarter 4 advising that Quarter 3 was presented at the last meeting but as this was not quorate is presented today along with Quarter 4 to complete the quarterly updates for the last financial year. There followed a brief discussion on these two reports and in response to a questions raised with regards to IJB’s role as Category 1 responder status and the risk control measures it was highlighted by the Chief Officer, Morag Barrow that 18 months ago the IJB were made Category 1 responders, although they don’t have a building or staff therefore it is about ensuring that the IJB is linking in with partner organisations around their category one status and operationally being part of their planning, it is again around the wording of this item. Mr McCann stated it would be helpful if the wording could be looked at regarding this point and asked a further question with regards to only one quarter report being presented to the committee at one time and following further discussion it was agreed that having updates in the table to allow comparison back through the quarters would be helpful. Further discussion followed with regards to controls in place and where the risks sit – should they be on the IJB risk register or is it more operational, it was agreed that this required further discussion to explore how this could be presented clearer to the board. Page 47 of 348
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6 Audit and Risk Committee Wednesday 28 June 2023 Action: • It was agreed moving forward into 2023/24, after Quarter 1 reporting, Quarter 2 will retain Quarter 1 and what was approved and then carry on like this each quarter. • Further discussion to take place with regards to exploring how these risks are presented • To otherwise approve Quarter 3 and Quarter 4 Risk Profiles. 5.5 Midlothian Integration Joint Board Internal Audit Annual Plan 2022/23 The purpose of this report is to gain approval to the proposed Internal Audit Annual Plan 2023/24 for the Midlothian Health and Social Care Integration Joint Board (MIJB) to enable the MIJB Chief Internal Auditor to prepare the annual opinion on the adequacy of the overall control environment of the Midlothian Health and Social Care Integration Joint Board. Chief Internal Auditor, Duncan Stainbank presented this report advising that this report was brough forward from the last committee and Appendix 1 to the report outlines the Internal Audit Plan 2023/24. Mr Stainbank advised that this audit work was managed and completed by Midlothian Council internal audit team in conjunction with some resources provided from the NHS internal audit team. Mr Stainbank in responding to a question raised by Mr McCann provided clarity on the IJB’s publication scheme advising that this identifies all public documents and the way in which the IJB communicates with the public over such items as the Strategic plan. Following a brief discussion on this audit and the resources and number of days to complete the audit, Mr Stainbank agreed that once all the resources were secured, he would consider the balance and probably put more resource time on the direction setting. Ms Flanagan also provided a further explanation on the challenges previously in obtaining the full resource from the NHS audit team and the reasons why this is put against a planned audit. Mr Fleming raised a question with regards to the biggest risks and the process and order in which the audits are undertaken and what gives most value and Mr Stainbank provided some clarity on how they determine which audits to consider by reviewing the risk register and also work that has been completed in previous years. He further advised that he is open to keep this flexible and if over the course of the year there is a need to reconsider the plan and it can be brought back to the Audit committee with revised elements. Further discussion took place regarding the plan and Mr Stainbank advised that considerable discussion regarding performance framework had taken place and the decision was that that would sit better in the 2024/25 audit plan when it has been developed and implemented a bit further on to give the best value. Following the discussion Mr Stainbank agreed that for future plans they will demonstrate some of the items they have looked at and also items for consideration for future years, so assurances are given when presenting the plan that they have all been considered. Page 48 of 348
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7 Audit and Risk Committee Wednesday 28 June 2023 Action: In going forward to reflect in future plans items which have been looked at and also items for consideration for future years, so assurances are given when presenting the plan that they have all been considered. To otherwise approve the report. 5.6 Midlothian Integration Joint Board Medium Term Financial Planning Report The purpose of this report is to present the findings and recommendations from the recently completed Internal Audit review of Medium- Term Financial Planning, completed in partnership between the Midlothian Council and NHS Lothian Internal Audit teams. As part of the Internal Audit Plan for 2022/23, approved by the audit and risk committee on 3 March 2022, an Internal Audit of Medium-Term Financial Planning. The report presents the findings of the review with the internal audit work undertaken by the NHS Lothian Internal Audit team and managed through the Midlothian Council Internal Audit team. The report provides 3 medium and 1 low rated recommendation that have all been agreed by the Chief Financial Officer Chief Internal Auditor, Duncan Stainbank presented this report highlighting the main sections as contained within the report. The Chair thanked Mr Stainbank for the report advising that a lot of what was detailed in the report has already been covered. Action: To note the report. 6. Private Reports No private business to be discussed at this meeting. 7. Date of next meeting The next meeting will be held on Thursday 7 September 2023 at 2 pm. (Action: All Members to Note) The Chair advised that Ms Flanagan will be leaving her role as Chief Financial Officer and has been successful in getting a promoted post within NHS Lothian and expressed his congratulations and thanks to Ms Flanagan. The meeting terminated at 3.11 pm. Page 49 of 348
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Midlothian Integration Joint Board Meeting Date Time Venue Audit and Risk Committee Thursday 7 September 2023 2.00pm Virtual Meeting held using MS Teams. Present (voting members): Val de Souza (Chair) Cllr Connor McManus Cllr Kelly Parry Andrew Fleming Present (non-voting members): Morag Barrow (Chief Officer) Claire Flanagan (Chief Finance Officer) Derek Oliver (Chief Officer Place) Duncan Stainbank (Chief Internal Auditor) In attendance: Gill Main (Integration Manager) Kay Jenks (Audit Scotland, External Auditor) Saty Kaur (Chief Officer Corporate Solutions (Acting)) Gary Leadbetter (Democratic Services Officer) Apologies: Nadin Akta MIJB Audit and Risk Committee 2023 Item No 4.1 Page 51 of 348
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2 Audit and Risk Committee Thursday 7 September 2023 1. Welcome and Introductions The Chair welcomed everyone to the meeting. 2. Order of Business The Order of Business was as detailed in the agenda. 3. Declarations of interest No declarations of interest were received. 4. Minutes of Meeting 4.1 The Minutes of Meeting of the Audit and Risk Committee held on Wednesday 28 June 2023 was submitted and approved as a correct record. 4.2 Matters Arising: None. 5. Public Reports 5.1 Update on Audited Annual Accounts 2022/23 and External Audit Report 2022/23 Process - CFO Verbal Update Chief Finance Officer, Claire Flanagan provided a verbal update on Audited Annual Accounts 2022/23 and External Audit Report 2022/23 Process. Ms Flanagan advised that the Audited Annual Accounts and External Audit Report would normally be presented at the September Midlothian Integration Joint Board (IJB) Audit and Risk Committee. Ms Flanagan explained that the external auditor, Audit Scotland, had been experiencing some resourcing issues leading to potential delays in meeting the September deadline, although work was back on track after both herself and the team had been working with the external auditors to meet this deadline, they had missed the deadline for submission to the Committee. Ms Flanagan explained that, in line with the IGB Standing Orders, the accounts need to be approved by one Page 52 of 348
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3 Audit and Risk Committee Thursday 7 September 2023 of the IGB’s Standing Committees, so the plan is that on 21 September 2023, under the Special MIJB Business Meeting and Development Session the accounts and audit report would be presented for approving the former and noting the latter. The Chair noted the update and opened it up for questions and comments. External Auditor, Kay Jenks advised that work was on track to be completed by 21 September 2023. Andrew Fleming queried if the Special IJB Development Session on 21 September 2023 would be virtual. Chief Officer, Morag Barrow confirmed that the meeting would be virtual. The Chair thanks Ms Flanagan and Ms Jenks for their updates and assurances. Action: • The Members noted the reasons for the non-submission of the Audited Annual Accounts 2022/23 and External Audit Report 2022/23 and agreed to their submission at the Special MIJB Business Meeting and Development Session on 21 September 2023. 5.2 Risk Register – Chief Office Place, Derek Oliver The Integrated Joint Board (IJB) Audit and Risk Committee maintains a strategic risk profile which is regularly scrutinised. However, it is important that Midlothian IJB is kept informed of its key risks and the actions undertaken to manage these risks. This report contains the strategic risk profile covering Quarter 1 2023/24, 1 April 2023 – 30 June 2023. Chief Officer, Place, Derek Oliver presented the Strategic Risk Profile for Quarter 1 2023/24, advising that this was appended to the report and that there had been no new risks or changes to Risk Evaluation into Quarter 1 from previous Quarter 4 2022/23. Page 53 of 348
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4 Audit and Risk Committee Thursday 7 September 2023 Mr Oliver advised that there remained to be one critical risk, with respect to ‘Impact of New Legislation’ and two high risks, with respect to ‘Financial Sustainability’ and ‘Workforce Recruitment and Retention.’ The Chair thanked Mr Oliver for the report and opened it up for questions. Chief Officer, Morag Barrow highlighted that, in relation to the financial situation, it was set to be a difficult year for both elements of the budget in terms of both the Council spend and NHS spend currently projecting overspend. Ms Barrow advised that work was ongoing with teams and recovery actions were being employed where possible and that some recovery had been achieved in comparison to Quarter 1. Ms Barrow noted some of the significant challenges being experienced, such as prescribing and overspend in learning and disability. Ms Barrow provided reassurance that work to address these challenges was ongoing. Andrew Fleming raised a question as to whether there was a duplication of risks, noting that ‘Issuing of Directions’ and ‘Financial Sustainability’ sounded similar in respect of financial resources. Mr Fleming also questioned whether the assurance reporting in relation to the risk ‘Category 1 Responder Status’ included desktop exercising, particularly as winter is coming and the challenges this can present. Integration Manager, Gill Main, so as to provide context to the Strategic Risk Profile, advised that there had been work to strengthen internal understanding of the difference between strategic and operational work, some of which has involved the Health and Social Care Partnership (HSCP) realising significant change to its governance structure whilst ensuring there is a robust system in place, which in turn has had a knock on effect on recognising strategic risks. Ms Main explained that, in respect of this, there is still realignment work to be completed and this may be some of the reason around potential duplication. Action: • Chief Officer, Place, Derek Oliver to meet with Andrew Fleming to provide insight into the Strategic Risk Profile. • The Members approved the Quarter 1 2023/24 Strategic Risk Profile. 5.3 Recommissioning in Matter of Focus and Outnav – Integration Manager, Gill Main This paper describes the work to establish an integrated performance framework across health and social care and details the proposal and identified funding for continuing this work. A high level overview (appendix 1) is provided of work jointly undertaken by Midlothian Health and Page 54 of 348
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5 Audit and Risk Committee Thursday 7 September 2023 Social Care Partnership (HSCP) and Matter of Focus to deliver the commission from Midlothian Integration Joint Board (IJB) of developing a performance measurement tool that provides strategic assurance, assurance on the organisational progress towards the 6 strategic aims of the Strategic Commissioning Plan 2022/25, and meets national ambitions in relation to understanding of our contribution to improving outcomes for people and communities. This paper also notes the requirement and intention to support and to develop the organisations understanding of service outputs vs personal outcomes and to better maximise the impact of qualitative data in environments where quantitative data is more frequently requested or valued. Integration Manager, Gill Main introduced the report, advising that the Matter of Focus work has been a historically more expensive contract than what is being proposed, as this has been significantly reduced by over fifty percent for a contract over the next two years. Ms Main highlighted that, as result of this report, Members are asked to: • Review the performance of the Matter of Focus Outcomes Measurement Project Commissioned in 2020 noting: - that performance against this contract has met and exceeded expectation with significant positive impacts, - where performance could be improved with integrated working, and the benefits of developing this practice, - the integral role outcome measurement has in the Midlothian IJB and both Midlothian HSCP Performance Framework and Integrated Governance Framework. • Approve the use of £49,986 of identified funding to be enable the ongoing - provision of service described in the proposal for 2023/25 - provision of the strategic governance required for Midlothian IJB - provision of the assurance Midlothian IJB requires of Midlothian HSCP in relation to performance measurements and operational governance through this triangulated approach - provision of support for services to deliver on Midlothian IJB Directions 3.1 and 3.3. • Note the requirement to develop the organisation’s understanding of - service outputs vs personal outcomes - the impact of qualitative data in environments where quantitative data is more frequently requested or valued. The Chair commended the report and opened it for questions and comments. Page 55 of 348
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6 Audit and Risk Committee Thursday 7 September 2023 Andrew Fleming raised a question on how this work was being received by staff, given that there are inherent challenges such as understanding how to use a new system which is being embedded. Mr Fleming also questioned what the ongoing contractual and commercial relation with Matter of Focus is, particularly if they are the proprietors of the OutNav software. In response to Mr Fleming’s former question, Chief Officer, Morag Barrow advised that reception had been mixed, with some staff groups embracing the new system with its novel opportunity to capture and measure performance in their service in a novel way. Ms Barrow stated that there are other staff groups that are more resistant. Ms Barrow recognised that this is a significant piece of work that will take time, expressing confidence in the ability to successfully complete the work. In response to Mr Fleming’s latter question, Ms Main advised that Matter of Focus were the only organisation able to provide the OutNav software. Ms Main further advised that the threshold for tendering was not being breached, so the relationship is appropriate and well governed financially. Ms Main noted that the relationship with Matter of Focus has been mutually beneficial and that the relationship and governance has been well received. The Chair raised a question around motivating the staff through making the work more tangible in terms of the impact on their day-to-day job. Ms Main, in response, highlighted and recognised that the change management process is difficult as it is expected that staff will react and adapt to change at different paces and in different ways, whilst some may never fully accept the change. Ms Main advised that every service had recognised that this new system helps them visualise part of their activities in a unique way that they were previously unable to. Ms Main stated that they were working to recognise where people were struggling or fearful, so that they could be supported, which in turn has also produced useful learning. The Chair raised a question around the existence and use of contribution analysis. Ms Main stated that there is very little work in health and social care that is attributional, yet much of the way that success or activity is recorded for statutory reporting is attributional. Ms Main noted that this can cause difficulties in attributing the work done, as part of a system, to a change in a personal outcome. Ms Main advised that they are working to help services change their thinking about how they capture activity, so contribution is shown, and that services are indeed moving in this direction. The Chair thanked and complimented Ms Main for the report. Page 56 of 348
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7 Audit and Risk Committee Thursday 7 September 2023 Action: The Members agreed to and approved the three recommendations contained within the report. 5.4 Additional Meeting Required Oct/Nov 2023 – CFO Verbal Update Chief Finance Officer, Claire Flanagan advised that the IJB Audit and Risk Committee is required to meet at least four times each financial year as per paragraph 9 in the Scheme of Administration. Ms Flanagan advised that the Committee held in March was not quorate and as such there is a requirement to hold an additional quorate meeting to satisfy the requirement of four times. Ms Flanagan recommended that a Committee meeting be scheduled for October/November 2023. Action: The Members noted the requirement to hold an additional meeting. Ms Flanagan to coordinate the scheduling of this additional meeting, in October/November 2023, with the Democratic Services team. 6. Private Reports No private business to be discussed at this meeting. 7. Date of next meeting The next scheduled meeting will be held on Thursday 7 December, with recognition that a meeting preceding this is to be scheduled for October/November 2023. The Chair noted that Nadin had offered her apologies. The Chair noted that it was Chief Finance Officer, Claire Flanagan’s final meeting at an IJB Audit & Risk Committee and thanked her for time and contribution. (Action: All Members to Note) The meeting terminated at 14:43 Page 57 of 348
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Midlothian Integration Joint Board Meeting Date Time Venue Audit and Risk Committee Thursday 23 November 2023 10.00am Virtual Meeting held using MS Teams. Present (voting members): Val de Souza (Chair) Cllr Connor McManus Nadin Akta Present (non-voting members): Morag Barrow (Chief Officer) Claire Flanagan (Chief Finance Officer) Claire Gardiner (Audit Scotland, External Auditor) Patricia Fraser (Audit Scotland, External Auditor) In attendance: Alan Turpie (Legal Services Manager) Gary Leadbetter (Democratic Services Officer) Apologies: MIJB Audit and Risk Committee Thursday, 7 December 2023 Item No 4.1 Page 59 of 348
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2 Audit and Risk Committee Thursday 23 November 2023 1. Welcome and Introductions The Chair welcomed everyone to the meeting. 2. Order of Business The Order of Business was as detailed in the agenda. 3. Declarations of interest No declarations of interest were received. 4. Minutes of Meeting 4.1 The Minute of Meeting of the Audit and Risk Committee held on Thursday 7 September 2023 was submitted and approved as a correct record. 4.2 Matters Arising: None. 5. Public Reports 5.1 MIJB Annual Audit Report – Year Ended 31 March 2023, report by Audit Scotland Claire Gardiner, Audit Scotland, External Auditors presented the Midlothian Integration Joint Board (MIJB) Annual Audit Report – Year Ended 31 March 2023. Claire Gardiner provided apologies for the delay in the submission of the audit, explaining the difficulties presented around catching up to pre-Covid timescales noting this was not specific to MIJB. Claire Gardiner noted that the report was in two parts, the first providing conclusions on the financial statements audit work, noting that Audit Scotland intend to provide a clean, unmodified audit opinion and it further provides references to significant audit matters and unadjusted errors. Claire Gardiner noted that it also includes a letter of representation, which provides assurances from the MIJB with regard to key judgements on the annual report, including fraud. Claire Gardiner asked that, before the letter is approved, the Members of the Committee consider any knowledge of actual or alleged fraud, non-compliance with laws or regulations or post-balance sheet events. Page 60 of 348
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3 Audit and Risk Committee Thursday 23 November 2023 The Chair, Val de Souza, asked if the Members had any comments to provide on the request from Claire Gardiner. No comments or matters were raised. Claire Gardiner then noted that the second part of the report was the Annual Audit Report and highlighting key messages including that: • Exhibit 1 highlights that materiality has increased from planning, and this is in relation to the increase in gross expenditure. • Exhibit 2 shows one significant audit matter in the year. The issue highlight is to correct the disclosures in the management commentary around social work and to improve the clarity for the reader. Audit Scotland is satisfied that the revised accounts are correct in this regard. • Paragraph 19 highlights the risks identified as part of the Annual Audit Plan and outlines the work completed in year and the results of this. There were no issues arising from the audit work to date and there were no adjustments over the reporting threshold that the Committee needs to be aware of. • Exhibit 4 notes that although the MIJB has a medium-term financial plan, updates are required to take into account revised funding levels and the 2023/24 recovery plan, and a recommendation has been made reflecting this at paragraph 37. • Three other recommendations have been made in relation to the wider scope work, which are outlined in the Action Plan at Appendix 1. These cover the risks associated with the loss of a Chief Finance Officer and areas identified with scope for improvement with regards to disclosure of register of interests and formalising reporting of best value. The Chair thanked Claire Gardiner for taking the Committee through the report and also for the explanation and apologies around the delay. Claire Flanagan, Chief Finance Officer, explained that they had seen the recommendations prior to the meeting and had worked with Audit Scotland in coming up with the responses. Claire Flanagan noted that the recommendation around financial sustainability is on the to-do list and it is now just the timing of when the funding partners develop their own financial plans to allow a financial plan to be brought to the MIJB. Morag Barrow, Chief Officer, queried whether there was an expectation to update the five-year financial plan on a monthly basis. Claire Gardiner explained that there is not expectation that this is done monthly and that Audit Scotland are comfortable with the current approach and plans. Noted that an annual process is sufficient. Morag Barrow also noted that in Section 2, Paragraph 36, the wording states that “Since February, further increases in funding have been agreed by Midlothian Council” and queried what this was in reference to. Morag Barrow stated that there was one non-recurring allocation, Page 61 of 348
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4 Audit and Risk Committee Thursday 23 November 2023 but that this year there was a reduction in funding from Midlothian Council. Patricia Fraser, Audit Scotland, External Auditors, explained that they had thought that initially Midlothian Council had not agreed to the funding that was requested by the MIJB but during the year they had increased the funding. If this is incorrect, the paragraph can be updated. It was agreed that the wording would be updated to reflect that additional funding received from Midlothian Council was non-recurring. Morag Barrow, providing an update on the Section 75 Officer, explained that David King, who has previously been Chief Finance Officer for East Lothian Council and Midlothian Council, will be covering the Chief Finance Officer / Section 75 Officer post until 31 March 2024 on an interim basis. Both partners are finalising a plan that Midlothian Council will pick up going forward. Claire Flanagan will present a paper at the next MIJB on 21 December 2023. Action: • Wording in Section 2, Paragraph 36 in the Annual Audit Report to be updated to reflect that additional funding received from Midlothian Council was non-recurring. • Members noted the Report. 5.2 2022/23 Audited Annual Accounts, report by Chief Finance Officer Claire Flanagan, Chief Finance Officer, presented the 2022/23 Audited Annual Accounts for the MIJB. As a statutory body, the IJB is required to produce a set of annual accounts at the end of its financial year (31 March). These accounts are then reviewed by the IJB’s external auditors who report their opinion of the IJB’s annual accounts to the IJB’s Audit and Risk Committee. This report having been agreed by the committee and presuming no outstanding issues, the IJBs annual accounts can then be approved. The accounts will then be signed by the Chair of the IJB, the Chief Officer of the IJB and the Chief Finance Officer of the IJB after which they will be published. Board members are asked to: 1. Note the report of the independent auditor. 2. Consider the 2022/23 annual accounts of the IJB. 3. Recommend approval of the accounts by Chief Officer in consultation with Chair and Vice-Chair in terms of Standing Order 15.1. Page 62 of 348
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5 Audit and Risk Committee Thursday 23 November 2023 Claire Flanagan highlighted the high-level points contained within the report, noting that: • The summarising of the year end position resulted a deficit of £10.3million, which should be seen in the context of the following: o MIJB generated a surplus in the financial year 2021/22, which was the result of funding being allocated by the Scottish Government during 2021/22 for the use in 2022/23. A significant proportion of this equated to the Covid funding allocation. Therefore, the deficit is a result of the MIJB incurring expenditure against its ear-marked reserves and the return of Covid funding that was not required. o MIJB’s financial performance against its in-year delegated budget, excluding ear-marked reserves did result in a small surplus, particularly within Social Care, so there was a small operational underspend within the Social Care budgets. o Overall, the Health budgets across the MIJB generated an overspend, therefore the partner NHS Lothian provided additional funding to the MIJB of £1.48 million. This is non-recurring financial support to break even all the Health budgets across the MIJB’s delegated health services. Claire Flanagan further highlighted that despite having a small operational underspend within the Social Care budgets, there are still significant areas of financial challenge and these budgets are the prescribing budgets and general medical services budgets. Claire Flanagan also noted that the Annual Governance Statement has now been included and the MIJB’s Chief Internal Auditor is involved in developing the report and has provide reasonable assurance for the overall adequacy and provided some actions and scope for improvement within the document. The Chair thanked Claire Flanagan for the report and opened it up to questions. No questions were received. Action: • Members approved the recommendations. • Claire Flanagan, Chief Finance Officer, Morag Barrow, Chief Officer and Councillor McManus, Chair of the MIJB will sign the Audited Annual Accounts electronically. 6. Private Reports Page 63 of 348
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6 Audit and Risk Committee Thursday 23 November 2023 No private business to be discussed at this meeting. 7. Date of next meeting The next scheduled meeting will be held on Thursday, 7 December 2023 at 14:00pm. (Action: All Members to Note) The meeting terminated at 10:36am Page 64 of 348
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Midlothian Integration Joint Board Thursday, 21st December 2023, 14:00-16:00 Midlothian IJB Membership Recommendations Executive summary This report provides information about non-voting member appointments to the Midlothian IJB and seeks the Board’s formal endorsement of them. This report also provides information in relation to required changes to the membership of the Audit and Risk Committee. Members are asked to: • Endorse the nominations for non-voting members of the Midlothian Integration Joint Board, • Review and approve the membership of the Audit and Risk Committee, • Welcome existing and new colleagues to the Midlothian IJB. # Item number: 5.1 Page 65 of 348
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Midlothian Integration Joint Board Midlothian Integration Joint Board Midlothian IJB Membership Recommendations 1 Purpose 1.1 This report notes and seeks the Board’s endorsement of nominations for non-voting members on the Midlothian Integration Joint Board. for membership, and to agree the appointment of the Third Sector Representative and AHP Professional Advisor as Board Members. 1.2 This report also provides information in relation to required changes to the membership of the Audit and Risk Committee. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Endorse the nominations for non-voting members of the Midlothian Integration Joint Board, • Review and approve the membership of the Audit and Risk Committee, • Welcome existing and new colleagues to the Midlothian IJB 3 Background and main report 3.1 The Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 determines the membership of Integration Joint Boards. This details the requirement to ensure members are representative of service users in the local authority, staff engaged in the provision of services, and third sector bodies carrying out activities related to health and social care in the local authority. 3.2 Hannah Cairns stood down as Chief AHP for Midlothian HSCP on 18th August 2023 and therefore also demitted office as a non-voting member of Midlothian IJB fulfilling the role of AHP Professional Advisor. Claire Ross took up post as the new Chief AHP for Midlothian HSCP on 25th September 2023. The Board is requested to endorse the nomination of Claire Ross as a new non-voting member of Midlothian IJB fulfilling the role of Professional AHP advisor to the Board 3.3 Miriam Leighton left her post with Midlothian Volunteer Association on 14th September 2023, and therefore also stood down from her role as a non-voting member of the Midlothian IJB in the role of Third Sector Representative. Magda Clark took up post as Volunteer Development Officer with Volunteer Midlothian on 28th September 2023. The Board is requested to endorse the nomination of Magda Clark as a new non-voting member of the Midlothian IJB fulfilling the role as Third Sector Representative to the Board. Page 66 of 348
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Midlothian Integration Joint Board Audit and Risk Committee 3.4 Under Standing Order 12.3, the IJB shall appoint all committee members, as well as the chair of any committees. The Board is invited to review the membership recommendations for the Audit and Risk Committee for approval. 3.5 Following taking up the position of Integrated Joint Board Chair, Councillor Connor McManus must step down from the Audit and Risk Committee. 3.6 Committee voting membership of the Audit and Risk Committee should consist of two Health Board representatives, and two Council representatives. To ensure this is maintained, it is recommended that the IJB consider and nominate a new Council member to join the Committee. 4 Policy Implications 4.1 There are no policy implications arising from this report. 5 Directions 5.1 There are no implications for Directions arising from this report. 6 Equalities Implications 6.1 There is no direct impact on inequalities arising from this report. 7 Resource Implications 7.1 There are no resource implications arising from this report. 8 Risk 8.1 Failure to appoint Integration Joint Board members would result in the Integration Joint Board being unable to meet the requirements of the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Act 2014 and the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014. 9 Involving people 9.1 The regulations and guidance accompanying the Public Bodies (Joint Working) Act (2014) requires the IJB membership to be reflective of those working in the delivery of health and social care in the community and should include representation from all key stakeholders. This includes staff, service users, voluntary bodies and independent organisations related to health and social care in the local authority. Page 67 of 348
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Midlothian Integration Joint Board 10 Background Papers 10.1 N/a. AUTHOR’S NAME AND DESIGNATION Emma-Jane Gunda, Assistant Strategic Programme Manager, Midlothian HSCP Gary Leadbetter, Democratic Services Officer, Democratic Services CONTACT INFO democratic.services@midlothian.gov.uk DATE 04th December 2023 Page 68 of 348
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Midlothian Integration Joint Board Thursday 21st December 2023, 14:00-16:00 Chief Officer’s Report Executive summary The paper sets out the key strategic updates for Midlothian IJB Board meeting December 2023. Board members are asked to: • Note the content of the report # Item number: 5.2 Page 69 of 348
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Midlothian Integration Joint Board Midlothian Integration Joint Board Chief Officer’s Report 1 Purpose 1.1 The paper sets out the key strategic updates for Midlothian IJB Board meeting December 2023. 2 Recommendations 2.1 As a result of this report Members are asked to: • Note the content of the report 3 Background and main report 3.1 Inspection The strategic joint inspection of Adult services with a focus on integration and outcomes for people with Physical disabilities, long-term conditions and their carers, was concluded with the publication of the final report on 28th of November 2023. This report outlines scrutiny themes and findings against 5 key indicators including leadership and commissioning. The Care Inspectorate and Health Improvement Scotland reviewed evidence provided by the Health and Social Care Partnership (HSCP) to understand our vision, aims, strategic planning and improvement activities. The evaluation against each of the 5 indicators were that of ‘Good’ (Grade 4). Some of the key strengths that were identified include people with Physical Disabilities and complex needs had positive experiences of integrated and person- centred health and social care which supported an improved quality of life. There was a positive and effective approach to early intervention and prevention, and this was prioritised across the workforce. There was also acknowledgement around the HSCP embedding a strengths-based outcomes approach to planning, delivery, and evaluation of its services. Priority areas for improvement included our continued need to address support for carers, ensure we have an integrated approach to providing information and advice around support, care and treatment and continue to support staff to be more confident in their knowledge of self-directed support. The learning from the inspection will be collated within an improvement plan and shared, monitored, and reviewed by the Care Inspectorate throughout 2024. 3.2 Staff Wellbeing The focus for the HSCP around staff communication, engagement and experience continues to focus on six development areas. Page 70 of 348
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Midlothian Integration Joint Board Development Area 1: Engagement Over 200 staff contributed to the Communication, Engagement and Experience Delivery Plan 23-24. The governance for this is situated within the Workforce Planning and Development subgroup. The group are currently reviewing measures around the actions within the plan. Development Area 2: Communication The HSCP Wellbeing Directory provides themed support (emotional, spiritual, learning, addiction, etc) for staff tailored to individual need. Promotion of this was distributed to all 1300 HSCP staff. Development Area 3: Programme of Support The HSCP ‘Changing Gear’ sessions encourage staff to transition from work to home including yoga sessions and circuit training. 39 sessions have been attended, with an average attendance of 10 people per session. Physiotherapy specialist services delivered trauma informed practical session and wellbeing support awareness for 42 staff. Monthly ‘Soup Stop’ staff lunches held at Midlothian Community Hospital continue, averaging 30 - 40 staff attending. Development Area 4: Leadership A leadership development session in October brought together around 50 leaders from all areas within the HSCP to build on the initial session held in May of this year. Sharing expectations of ourselves, others, the services and HSCP allows teams to share goals, prioritise and plan, understand differences and improve communication. This then resulted in some project work which aims to re-launch the ‘Midway’ - an HSCP wide commitment to ensure trauma-informed practice, ‘Good Conversations’, equalities, and values are embedded within all we do. Development Area 5: Mental Wellbeing In response to the most significant cause (anxiety, depression, stress, and trauma) of days lost to the Partnership, the HSPC has a programme of mental health support initiatives that include Mindfulness Mondays and Peer Support. Each of these services have yielded positive results. To date, there have been 14 half-hour staff sessions of ‘Mindfulness Mondays’ with an average of 8 staff attending. Feedback has been overwhelmingly positive with staff noting that ‘self-care has remained a priority for them’, they feel more equipped to cope with work pressures and overall resilience has improved. Further focus on applied Suicide Intervention Training was delivered to 23 trainees. Development Area 6: Environment We have created and developed 12 staff wellbeing spaces across the HSCP where staff can ‘Rest, Refresh and Refuel’. Data shows that the ‘Rest Refresh and Refuel’ webpage has been reviewed 536 times. Nick Clater, Head of Adult Services - nick.clater@midlothian.gov.uk 3.3 Vaccination programme Page 71 of 348
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Midlothian Integration Joint Board The Autumn and Winter Vaccination Programme commenced on 4th of September 2023. All eligible cohorts will have received an invite to attend for vaccination by 11th of December, with mop-up activity taking place until 31st of March 2024. Vaccine uptake date (as of 28th November 2023): • All eligible cohorts for Flu 41% (25,868) • All eligible cohorts for Covid 57% (20,312) All care home resident vaccinations are complete. Housebound patients are on target to complete before 11th December with 85% patients having received their winter vaccines. Midlothian Community Hospital (MCH) In-patient vaccinations are complete with ongoing mop-ups. Inclusivity work Clinics have all now opened to drop-in clinics to promote the uptake of vaccinations. The team has offered drop-in clinics at Number 11, Mayfield Food Pantry, staff sessions at MCH and are exploring the use of IKEA for pop-up clinics. Looking ahead The team continue to deliver non-routine vaccinations, and in January 2024 eligible patients will be called forward for their Shingles and/or Pneumococcal vaccines. The National Shingles vaccination programme has expanded its eligibility criteria from September 2023, as defined in the Green Book Chapter 28a: • Routine vaccination of 70-year-olds (defined by age at 1st September 2023). • Routine vaccination of 65-year-olds (defined by age at 1st September 2023) • Vaccination of 71–79-year-olds (defined by age at 1st September 2023), who have not previously received shingles vaccination. Where an individual has turned 80 years of age following their first dose of Shingrix®, a second dose should be provided before the individual’s 81st birthday to complete the course. 3.4 Scottish Healthcare Awards The Midlothian Community Respiratory Team (CRT) and Midlothian Performance Team won a Scottish HealthCare Award for Asthma/COPD Project of the Year in November. The collaborative project is the development of an innovative data dashboard, designed and built by the HSCP Performance Team, which aims to improve the quality of care on offer through data driven service improvement. Grace Cowan, Head of Primary Care & Older People Grace.cowan@nhslothian.scot.nhs.uk Page 72 of 348
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Midlothian Integration Joint Board 3.5 Annual Performance Report (APR) 2022-23 Midlothian IJB's Annual Performance Report (APR) 2022-23 was presented to the IJB at the August Board meeting and published here: Midlothian Integration Joint Board Annual Report 2022-23. 3.6 Midlothian IJB Strategic Commissioning Plan 2025-40 The officers of the HSCP have launched the project plan for the development of the Midlothian IJB Strategic Commissioning Plan 2025-40. The initial phase of this work includes a significant scoping and stakeholder consultation period. Preliminary data and ideas for consideration and development will be shared with Midlothian IJB in the January 2024 Development Session. At this time the Board will determine key messages and priorities for review by the Strategic Planning Group and the next phase of our consultation plan as per statutory guidance. 3.7 Speak Up Week Supported by the Strategic Programme Manager for Workforce, Midlothian HSCP held a week of events from the 2nd to the 6th of October 2023. The theme of the week was ‘Learning from Concerns’ and everyone was encouraged to get involved to help encourage a good speak up culture. Every day, content around a particular topic was shared through events, blogs and videos across our sites and social media channels. 3.8 Midlothian Local Development Plan As previously reported, a significant piece of work to understand the impact on health and social care of the scale of predicted population and household growth in Midlothian between 2023 and 2036 has been completed. This additionally raises questions about the legitimate review of the Lothian NRAC as predicted population growth due to housing development is not proportionate across Scotland. Subsequently, and alongside discussion with Midlothian IJB, Scottish Government have committed to a review of the NRAC formula. 3.9 Midlothian HSCP Integrated Workforce Governance Board Supported by the Strategic Programme Manager for Workforce and the Integration Manager as executive sponsor, the Midlothian HSCP Integrated Workforce Governance Board chaired by Morag Barrow has now met twice. Establishing the workforce governance structure within Midlothian will support the Board and the HSCP to work alongside our NHS and Local Authority partners to meet the duties of the Health and Care (Staffing) (Scotland) Act 2019. As part of this new governance and support structure, two Subgroups have also been established: Workforce Planning (Access and Demand) chaired by the Integration Manager, and Workforce Engagement (Staff Governance and Development) chaired by the Group Service Manager. 3.10 Third Sector Summit A successful and well attended Third Sector Summit was held on Tuesday 21st November 2023. Plans continue to progress to hold regular summits biannually and jointly led by the HSCP and Midlothian Third Sector Interface (TSI). Page 73 of 348
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Midlothian Integration Joint Board Midlothian HSCP alongside Midlothian Third Sector Interface, hosted the second Third Sector Summit of the year on November 21st, 2023. Third Sector Summits aims to provide a collaborative forum where the Third Sector and providers across health and social care can come together. The event was attended by over thirty individuals from various HSCP and Third Sector organisations based in Midlothian. The agenda focused on older people & the financial hardships they face, with presentations from the Midlothian Financial Inclusion Network (MFIN) & Women’s Aid sparked discussion from the forum membership about opportunities to improve outcomes for people in the community. Key points for action were to increase awareness of existing community support, continue to raise the impact of limited transport links for older people, and how to improve the use of single points of access where services already engage with people were all noted. The first stage of public consultation for the next IJB Strategic Plan was also highlighted at the event. 3.11 Measuring Outcomes and Impact Officers of Midlothian HSCP were invited to share Midlothian’s work on relational performance, outcome measurement and strategic governance at the Oxford University Blavatnik School of Government in September 2023. Audit Scotland and Healthcare Improvement Scotland have both asked to work with the Planning and Performance team and recently reviewed this work. We continue to liaise with both of these national organisations on how to develop this framework and share as an example of best practice. 3.12 National Improvement Framework for Adult Social Care and Community Health The HSCP have been asked to contribute to the development of the National Improvement Framework for Adult Social Care and Community Health. An initial meeting was held on 10th November 2023 to share learning and discuss how the team can continue to support the national team better understand approaches to measuring personal outcomes. 3.13 Integrated Impact Assessments (IIA) In Summer of 2023 the HSCP collaborated with NHS Lothians’ Head of Equality and Human Rights to devise a more comprehensive approach to Integrated Impact Assessments (IIA). This new approach aimed to better support those conducting IIAs, offer more detailed guidance, and help people take action to reduce inequalities as a result. This approach provides significantly greater assurance that statutory duties were being fulfilled to improve lives and experiences of people in our communities. During development, a range of stakeholders were given the opportunity to offer feedback on the new IIA paperwork including trade unions, NHS Lothian Public Health Directorate, NHS Lothian Equality and Human Rights Group and NHS Lothian Corporate Management Team (CMT) and health and social care services. As part of this process, Midlothian HSCP trialled the new IIA documentation with two projects. Feedback on use was positive and noted that the new documentation supported those collaborating on the IIA to think broadly and practically about a full range of aspects relevant in supporting a human rights approach to impact assessment. Page 74 of 348
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Midlothian Integration Joint Board Midlothian HSCP continue to support the ambition to adopt a single process across all Lothian health and social care organisations. Gill Main, Integration Manager - Gill.main3@nhslothian.scot.nhs.uk 3.14 Publication of Midlothian end of life care project findings A project funded by the Scottish Government and Marie Curie to explore ways of gathering feedback about the delivery of end-of-life care was undertaken in Midlothian HSCP during 2021 and 2022. Following completion of the project a small writing group was established as one of the actions to share learning from the project. We are delighted that an article was accepted by the British Journal of Community Nursing and has now been published (see link below). The project was also presented at the recent NHS Lothian Research Conference; it is an important and sensitive topic as none of us is untouched by the experience of losing a loved one. The presentation was powerful and well received. Work continues to share the learning for inclusion in undergraduate education and in to inform CPD opportunities for a range of staff across NHS Lothian and beyond. Exploring the delivery of end-of-life care by community nurses | British Journal of Community Nursing (magonlinelibrary.com) Fiona Stratton, Chief Nurse - Fiona.stratton@nhslothian.scot.nhs.uk 3.15 GP Resilience Planning Activity in primary care remains high compared with other HSCPs, with over 514,000 direct patient encounters this year to date. All 11 practices currently have lists open to registration of new patients. The mid-year review of the HSCP Primary Care Improvement Plan (PCIP) has provided reassurance that Scottish Government funding has been productively utilised to secure workforce for the implementation Community Treatment Assessment Centres and pharmacotherapy services in all 11 practices. It is recognised that there is still work to be done and further resource is needed to fully deliver on the expectations of the New Contract MOU2, but meantime work continues on optimising service delivery for patients across Midlothian. For example, about 1,150 patients are seen each month by the Musculoskeletal Advanced Physiotherapy Practitioner service. 74% are new patients, and 86% are managed independently without any GP input. Onward referral rates to the Musculoskeletal waiting list are falling (and are the lowest in Lothian) which is maintaining capacity and accessibility for patients. A new collaborative project between GP practices and the HSCP pharmacotherapy teams has achieved a 2.6% reduction in acute ad hoc prescriptions (i.e. those not issued as a regular repeat prescription). This equates to 11,260 less prescriptions issued in this way in the last 4 months alone, with a potential saving of 375 hours of GP and administrative time. This project continues to gain momentum and is part of a range of planned prescribing projects which aim to improve capacity in general practice, while improving safe access to medicines for patients. Page 75 of 348
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Midlothian Integration Joint Board Rebecca Green, Clinical Director - rebecca.green@nhslothian.scot.nhs.uk 4 Policy Implications 4.1 The issues outlined in this report relate to the integration of health and social care services and the delivery of policy objectives within the IJBs Strategic Plan. 5 Directions 5.1 The report reflects the ongoing work in support of the delivery of the current Directions issued by Midlothian IJB. 6 Equalities Implications 6.1 There are no specific equalities issues arising from this update report. 7 Resource Implications 7.1 There are no direct resource implications arising from this report. 8 Risk 8.1 The key risks associated with the delivery of services and programmes of work are articulated and monitored by managers and, where appropriate, reflected in the risk register. 9 Involving people 9.1 There continues to be ongoing engagement and involvement with key stakeholders across the Partnership to support development and delivery of services. 10 Background Papers AUTHOR’S NAME Morag Barrow DESIGNATION Chief Officer CONTACT INFO 0131 271 3402 DATE December 2023 // Page 76 of 348
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Midlothian Integration Joint Board Thursday 21st December 2023, 14:00-16:00 Interim Appointment of Chief Finance Officer Executive summary This report is provided for the Midlothian Integration Joint Board (IJB) on the proposals for the recruitment of the Chief Finance Officer / Section 95 Officer. Board members are asked to: • Accept the resignation of Claire Flanagan as Chief Finance Officer • Agree to the interim arrangements of Chief Finance Officer / Section 95 Officer • Note the arrangements for the IJBs Chief Finance Officer from 1st April 2024 with further updates at a future IJB meeting. # Item number: 5.3 Page 77 of 348
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Midlothian Integration Joint Board Midlothian Integration Joint Board Interim Appointment of Chief Finance Officer 1 Purpose 1.1 This report updates the Midlothian Integration Joint Board (IJB) on the arrangements for replacement of the Chief Finance Officer / Section 95 Officer. 2 Recommendations 2.1 The IJB is asked to: • Accept the resignation of Claire Flanagan as Chief Finance Officer • Agree to the interim arrangements of Chief Finance Officer / Section 95 Officer with David King taking up post as interim Chief Finance Officer. • Note the arrangements for the IJBs Chief Finance Officer from 1st April 2024 with further updates at a future IJB meeting. 3 Background and main report 3.1 The regulations on membership of IJBs include the appointment of “the proper officer of the integration joint board appointed under section 95 of the Local Government (Scotland) act 1973(1)”. 3.2 The IJB agreed in July 2015 that there should be a shared Chief Finance Officer / Section 95 Officer appointment between East Lothian and Midlothian IJBs, and that this would be subject to review. Claire Flanagan took up the role of Chief Finance Officer from the 1st of October 2018, Claire has now been recruited into a new role and therefore resigns as the IJBs Chief Finance Officer. 3.3 Following the resignation of the current Chief Finance Officer the decision to share this post has been reviewed and due to the size and scale of work involved in the role, it has been agreed that the each IJB would look to recruit their own Chief Finance Officer / Section 95 Officer. 3.4 The IJB requires to have a Chief Finance Officer / Section 95 Officer and therefore an interim arrangement for the post has been put in place. David King will return to the role as interim Chief Finance Officer / Section 95 Officer until the end of the financial year. 3.5 From the 1st of April 2024, the permanent replacement of Chief Finance Officer / Section 95 Officer for the IJB will be provided by Midlothian Council. The Councils Chief Finance Officer will also fulfil the Chief Finance Officer role to the IJB. 3.6 An update will be provided to the IJB at a future meeting. Page 78 of 348
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Midlothian Integration Joint Board 4 Policy Implications 4.1 There are no policy implications from this report. 4.2 The recommendations in this report implement national legislation, and regulations on the establishment of IJBs. 5 Directions 5.1 There are no Directions implications arising from this paper 6 Equalities Implications 6.1 There are no equalities implications from this report. 7 Resource Implications 7.1 There are no immediate resource implications from this report. Any resource implications from the outcome of the process will be highlighted in a future report if required for Board consideration. 8 Risk 8.1 The interim arrangements to provide the IJB with adequate Chief Finance Officer / Section 95 Officer cover minimises risk until the permanent role is fulfilled at the start of next financial year. 9 Involving people 9.1 The IJB is held in public and its papers publicly available. 10 Background Papers 10.1 None AUTHOR’S NAME Morag Barrow DESIGNATION Chief Officer CONTACT INFO Morag.barrow@nhslothian.scot.nhs.uk DATE December 2023 Page 79 of 348
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Midlothian Integration Joint Board Thursday 21st December 2023, 14:00-16:00 MIJB Medium-Term Financial Plan Executive summary The Midlothian Integration Joint Board (IJB) is required to prepare a medium-term financial plan. The IJB’s partners have now provided the IJB with their own financial plans for the period 2024/25 to 2028/29, and this information allows the IJB to build its own forecast. This shows: - Summary £000's £000's £000's £000's £000's Health (4,838) (6,265) (7,529) (8,856) (10,257) Social Care (7,724) (9,995) (12,302) (14,647) (17,030) Total (12,562) (16,260) (19,831) (23,503) (27,287) These values being overspends. It is important to note that this is a forecast based on an initial review. There is no impact of management actions in this position nor any further funding that may be made available. That said, the overall position is clear and the IJB will now, working closely with its partners, have to develop a series of recovery plans to bring it back into a balanced financial position. Members are asked to: • Note the forecast position from 2024/25 to 2028/29. • Consider the assumptions underlying this forecast. • Support the development of a recovery programme. Item number: 5.4 Page 81 of 348
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Midlothian Integration Joint Board Midlothian Integration Joint Board MIJB Medium-Term Financial Plan 1 Purpose 1.1 This report sets out the output from the initial review of the IJB’s projected financial position 2024/25 to 2028/29, discusses the background to the position and lays out the assumptions that underlie the forecast. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the forecast position from 2024/25 to 2028/29 • Consider the assumptions underlying this forecast • Support the development of a recovery programme 3 Background and main report 3.1 The IJB is governed by local authority regulations and, like Councils, the IJB must set a balanced budget before 1st April every year. It is worth noting that the NHS Boards are governed by different financial regulations and must break-even at the end of each financial year. Thus, Midlothian Council will set a balanced budget based on the achievement of a range of efficiency plans for the following financial year whereas NHS Lothian will make a financial forecast (at the start of the current financial year) which shows the totality of the financial challenge and proposes a series of outline plans to move towards a break-even position by the end of the financial year. The IJB will also set a balanced budget for the next financial year and that will be based on a series of financial recovery actions which will, operationally, be delivered by the partners. 3.2 Both partners have provided information to allow the IJB to broadly project its financial position over the next five years. In summary this shows – Page 82 of 348
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Midlothian Integration Joint Board Where the variance is an overspend against the projected budgets in each year. 24/25 Variance 25/26 Variance 26/27 Variance 27/28 Variance 28/29 Variance Health Core (2,413) (3,193) (3,986) (4,803) (5,652) Hosted 175 (53) (158) (268) (385) Set Aside (2,600) (3,019) (3,385) (3,785) (4,219) Total Health (4,838) (6,265) (7,529) (8,856) (10,257) Social Care Opening (4,000) (7,824) (10,095) (12,402) (14,747) N/R support in 23/24 (1,583) Per MLC paper (1,241) (1,271) (1,307) (1,345) (1,383) Demography (1,000) (1,000) (1,000) (1,000) (1,000) Total Social Care (7,824) (10,095) (12,402) (14,747) (17,130) Total IJB (12,662) (16,360) (19,931) (23,603) (27,387) It should be noted that the above forecast does not show the impact of any management actions (recovery programmes) or any additional funding. In the absence of such actions and given that the demographic and inflationary pressures in future years are significantly greater than the funding available, the pressures will simply continue to increase. 3.3 Assumptions Both partners have started from slightly different places and have a different range of assumptions. Health NHS Lothian have assumed a 2% uplift every year along from the Scottish Government (which will be passed to the IJBs) with a 2% pay award to all staff. The underlying pressure (that is financial pressures supported non-recurrently in 22/23) is included in the forecast with no assumption of any other uplifts or non-recurrent funding. The pressure is therefore a reflection of the historical position plus new pressures arising from pay costs (beyond the pay award) and inflation on health provision generally (for example cost of new drugs). Social Care The social care budget will be subject to the offer made by the Council as part of its budget setting process and therefore the assumptions that underly this forecast may be changed through the Council budget setting process. Midlothian Council has produced their Medium-Term Financial Strategy which went to the Council on the 10th of October 2023. This lays out a flat cash settlement for the IJB over the period noted above. The schedule also shows the inflationary pressures across the Council, and this provides the IJB with a position for those pressures. There is also a provision for demographic growth, this is based on the historic value and may not Page 83 of 348
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Midlothian Integration Joint Board now represent the totality of this pressure. In order to address the underlying pressures currently in the system, the quarter 2 year-end adjusted forecast has been used and the elements of spend that are being supported non-recurrent from within the reserves in 2023/24 are also included. Appendix 1 further analyses the forecast above and discusses the nature of the pressures and the basis of any assumptions. 3.4 The Scottish Government will set its budget for 2024/25 during the month of December and this will provide further information about any further funding available. 3.5 Further work is being undertaken with both partners to review the assumptions above and discussions are underway to understand the impact of the Set Aside pressures (c. £3.0m in 2024/25 above) and how the IJB can manage this. 3.6 As is discussed above, the forecast itself requires to be reviewed and there will be further impacts on it from both the Scottish Government budget assumptions and the budget setting processes of the partners. However, it is highly unlikely that any further uplifts or funding will not have any material difference on the pressures laid out above and the IJB now needs a series of detailed financial proposals to allow it to live within the resources available to it. Plans are being progressed to prepare a series of workshops both with the operational management teams and the IJB itself, to discuss proposals and to ensure that the final plans adopted will support the delivery of the IJB’s objectives as laid out in its’ Strategic Plan. 4 Policy Implications 4.1 No further policy implications arise from this report. 5 Directions 5.1 No further directions are required from this report. 6 Equalities Implications 6.1 A recovery plan will unquestionably require a range of Impact Assessments to be made this will be developed as part of that programme. 7 Resource Implications 7.1 Resource implications are discussed above 8 Risk 8.1 The IJB’s risk register recognises the financial challenges noted in this report. Page 84 of 348
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Midlothian Integration Joint Board 9 Involving people 9.1 The IJB meets in public and publishes all of its papers. Proposals for recovery actions will be brought to the IJB and shared with the Strategic Planning Group. 10 Background Papers 10.1 Financial Plan, presented to the IJB, December 2022. AUTHOR’S NAME David King DESIGNATION Interim Chief Finance Officer CONTACT INFO David.king4@nhslothian.scot.nhs.uk DATE 5th December 2023 Appendices: Appendix1: Analysis of the Forecasting Model Page 85 of 348
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Appendix 1 – Further analysis of the five-year plan 24/25 Variance 25/26 Variance 26/27 Variance 27/28 Variance 28/29 Variance Health Core (2,413) (3,193) (3,986) (4,803) (5,652) Hosted 175 (53) (158) (268) (385) Set Aside (2,600) (3,019) (3,385) (3,785) (4,219) Total Health (4,838) (6,265) (7,529) (8,856) (10,257) Social Care Opening (4,000) (7,824) (10,095) (12,402) (14,747) N/R support in 23/24 (1,583) Per MLC paper (1,241) (1,271) (1,307) (1,345) (1,383) Demography (1,000) (1,000) (1,000) (1,000) (1,000) Total Social Care (7,824) (10,095) (12,402) (14,747) (17,130) Total IJB (12,662) (16,360) (19,931) (23,603) (27,387) 1. Sources Health - NHS Lothian updated five-year plan, November 2023. Social Care – Pressures are from the Medium Term Financial Strategy presented to Midlothian Council on 10th October 2023. That showed pay inflation at 3%. It’s still not clear what the inflationary uplifts for the contracts with third parties is – for example the national care home contract has not yet been agreed and this will also have to be included as part of the overall inflationary pressures As is discussed above, support from the IJB’s reserves in 2023/24 without further recovery programmes will impact on 2024/25. The non-recurrent support above is. £000's Funding from earmarked reserves (interim care) for Highbank staffing 458 Funding from earmarked reserves (Care at Home winter planning) for Newbyres staffing 675 Funding from general reserve for respite at Cowan Court 100 Use of Carers' money to offset loss of income from not charging for respite 170 Fieldwork staffing - from earmarked reserves (addtl. MHO capacity) 80 Sustainability Payments - one-off underspend 100 1,583 A provision for demography of £1,000,000 is included as a proxy for the demographic challenge. Further work is required to consider the adequacy of this. Page 87 of 348
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2. Levels of analysis Ideally forecasts would show underlying pressures, pressures from additional demand (demography and improvements in health care) and inflationary pressures. Although this data is in both the partner’s forecasts it is laid out in different ways. It should be possible to revise the current presentation and this approach will be used in future iterations of the financial plan. 3. Adjustment for consistency In order to ensure that both plans manage the issue of underlying pressures consistently, a further line has been added to the Social Care forecast. This shows the underlying pressures from 2023/24 in the brought forward row and then brings forward the pressures for each previous year. As is described above, given that there is no impact of management actions in these positions and that inflationary and demographic pressures are considerably greater that any assumed uplift then the values will increase. It should be noted that management actions currently underway and recovery plans adopted by the IJB for 2024/25 will impact favourably on future years. 4. Demographic Change Scottish Government funds for both partners are distributed according to national formulae. Midlothian particularly and NHS Lothian generally have increasing populations, and therefore face increased demand for health and social care services for which the current funding models are not currently providing the appropriate resources. Page 88 of 348
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Midlothian Integration Joint Board Thursday, 21st December 2023, 14:00-16:00 MIJB Finance Update - Quarter 2, 2023/24 Executive summary This paper lays out the Midlothian Integration Joint Board’s (IJB) quarter 2 year-end financial forecast for 2023/24, information for which has now been provided by the IJB’s partners. This shows a total projected overspend in 2023/24 of £8.6m, the quarter 1 forecast showed an overspend of £7.8m. This is based on the month 6 position, and it should be noted that the IJB’s partners’ management teams have been and continue to develop recovery plans to manage this position. The paper also considers the current position of the IJB’s reserves and notes that the general reserve is now at its agreed minimum value, that is 2% of the IJB’s turnover. The IJB’s Annual Accounts for 2022/23 have now been approved by the IJB’s Audit and Risk committee. Members are asked to: • Note the output from the Quarter 2 report • Note the current position of the IJB’s reserves • Note that the 2022/23 Annual Accounts have now been approved # Item number: 5.5 Page 89 of 348
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Midlothian Integration Joint Board Midlothian Integration Joint Board MIJB Finance Update – Quarter 2, 2023/24 1 Purpose 1 This report sets out the output from the quarter 2 2023/24 year-end out-turn forecasts by the IJB’s partners, a review of the IJB reserves in 2023/24, and notes that the IJB’s 2022/23 Annual Accounts have now been approved by the IJB’s Audit and Risk Committee. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the quarter 2 2023/24 year-end forecast out-turn. • Note the position of the IJB’s reserves • Note that the IJB’s Annual Accounts for 2022/23 have been approved by the Audit and Risk Committee. 3 Background and main report 3.1 Quarter 2 Review Both partners have now completed their quarter 2 financial reviews which include a projected out-turn for the financial year 2023/24. It is important to remember that this work is based on the financial position at month 6 (September) and that any unfavourable positions have already attracted management actions by the partners’ management teams. 3.2 The output is as follows – Values are variances, favourable/(unfavourable) The quarter 1 year-end out-turn forecast projected an overspend of £7,871,000 the health position having improved slightly but the social care forecast has deteriorated by c £1.1m. £000's Health Core (1,876) Health Hosted 321 Health Set Aside (1,615) Total Health (3,170) Social Care (5,500) Total (8,670) Page 90 of 348
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Midlothian Integration Joint Board 3.2.1 Health Position Within the Core health services, that is the health services delivered locally within Midlothian and managed by the Health and Social Care Partnership (HSCP), the main pressures are an overspend within the GP Prescribing budget and pressures within the nursing budgets, although this is offset by underspends within other budgets. Set-Aside health services are those functions delegated to the IJB but managed by the Acute Hospital Teams at the Royal Infirmary of Edinburgh and Western General Hospital. These are all services which are not trauma, cancer or surgical. The financial model that supports the reporting of such services is currently being reviewed in order to both ensure that the correct budgets are available to the IJB, and the correct charges against those budgets, and that reporting of the Set-Aside position is improved. 3.2.2 Social Care Position Unlike health services which are almost entirely delivered by a range of directly employed staff, or very clearly defined contracts in the case of General Medical Services, many social care services are delivered by commissions through third parties – for example most care home places and most of Care at Home. It is difficult to forecast over the longer period the value of the commitments made by the Council against the provider contracts, as the future delivery of services to clients may change as client needs change. Finance colleagues have been considering previous year’s forecast cycles and it is clear that forecasts improve over the financial year as the commitments in the system are crystallised. It is estimated that the forecast may be overstated by c. £1.5m which would reduce the social care forecast above to £4.0m of an overspend. 3.3 Management and recovery actions Health NHS Lothian had received additional funds to support in-year financial pressures from the Scottish Government. It has decided that GP prescribing pressures should be supported by these funds and an additional £0.8m is being made available to the IJB. This will improve the health position above. NHS Lothian is keen to continue its model of providing financial support to the IJBs assuming that it can itself break-even in year. Social Care Given that the forecast for 23/24 is a significant overspend and the out-turn position in 22/23 was a modest underspend, it’s worth noting that an additional £8.6m was allocated to the IJB by the Scottish Government through Midlothian Council as part of the 2022/23 budget settlement. These funds were part of the Scottish Government’s budget settlement for 2022/23 and although they were largely absorbed during the financial year by pay awards and other inflationary pressures, there were some resources left over to contribute towards an element of demographic pressures. The budget settlement for 2023/24 has been discussed in detail at previous meetings of the IJB but created additional financial challenges in 2023/24. The HSCP management team has been addressing these financial challenges and developing a series of recovery plans. 3.4 The IJB’s scheme of Integration provides for the challenge of in-year budget pressures. As was described in the October Finance paper to the IJB in the first instance, the parties management teams must prepare a recovery plan. This work is Page 91 of 348
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Midlothian Integration Joint Board underway – and has been so during the financial year – and further financial positions for 2023/24 will be brought back to the IJB at its’ next meeting. 3.5 IJB Reserves As was discussed in the October 2023 paper, the IJB has two ‘classes’ of reserves. i) Earmarked reserves. These are funds carried over from previous financial years for a specific purpose. This is to allow funds to be allocated in year 1 but expenditure to be made over a period of years thereafter. There is generally a presumption that having expended such earmarked reserves for the purpose allocated then the expenditure will either cease or a new funding stream will be identified. Thus, most of the earmarked reserves should not, in principle, create financial pressures in future years. However, as a result of the additional funds received for the 2022/23 financial year, some funds have been earmarked for a broader purpose – for example funding for Interim Care and Care at Home. These funds have been used to support the 2023/24 position for these services, both of which are currently overspent, but the funds will not be available in 2024/25. This will increase the financial pressures against these services in 2024/25. ii) General Reserves. The general reserve is built up from surpluses in the IJB budgets – that is underspends against the partners operational budgets. The general reserve should only used either as non-recurrent funding to develop services or as a last resort to underpin the financial position at the year-end. The current position is as follows: - £000's General Reserves at 31/3/2023 6,182 Support Planning Team in 23/24 -388 Support Bottom Line in 23/24 -460 Planning team future commitments -1,754 Balance at 31/3/2024 3,580 The transactions are as follows: - a) The IJB agreed to support the development of a Planning and Performance team and fund it from its general reserve. The costs of the 2023/24 position being £388,000 and the last line above showing the projected future costs from 2024/25 to 2027/28. b) As part of the budget setting process in 2023/24, the IJB agreed to support the 2023/24 financial position non-recurrently from the general reserves. This was laid out in the August IJB finance paper. The IJB’s reserve strategy policy is 2% of turnover. This is c. £3,400,000. Any further utilisation of the IJB’s reserves in 2023/24 will reduce the general reserve to less that the policy value. The IJB may wish to consider the future commitments against the general reserve. 3.6 Impact of 2023/24 financial position on 2024/25 The IJB set a balanced budget at the start of 2023/24. This was based on a series of efficiency plans (‘savings’) being achieved to balance the budget having considered the projected pressures in the system and the budget offers from the partners. As described Page 92 of 348
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Midlothian Integration Joint Board above, an overspend is forecast at quarter 2 which consists of both new pressures and challenges in delivering the efficiency programmes build into the opening budgetary process. The key here is to understand the recurrency of these financial pressures and to ensure that this is included in the 2024/25 budget setting process. Work continues with the partners’ management teams to develop this analysis and to ensure that this will clearly form part of the budget setting process in March 2024. 4 Policy Implications 4.1 There are no new policies arising from this report 5 Directions 5.1 This report does not require amendments to any current direction or the creation of a new direction. 6 Equalities Implications 6.1 This report in and of itself has no further equalities implications at this stage. 7 Resource Implications 7.1 The resources implications are laid out in the report. 8 Risk 8.1 The IJB’s risk register notes the challenge within the IJB’s financial position. 9 Involving people 9.1 There are no implication for involving people. 10 Background Papers 10.1 Finance Update – Quarter 1, presented to the IJB at its August 2023 meeting. AUTHOR’S NAME David King DESIGNATION Interim Chief Finance Officer CONTACT INFO David.king4@nhslothian.scot.nhs.uk DATE 5th December 2023 Appendices: Appendix 1: Midlothian IJB Month 6 report, NHS Lothian Appendix 2: Adult Social Care – Delegated to IJB, Q2 report Page 93 of 348
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Midlothian IJB Annual Budget '000 Midlothian IJB YTD Budget £'000 NHS Services Core 75,285 35,477 Corporate 598 598 Hosted 15,790 7,301 Acute 21,645 10,403 Grand Total: 113,319 53,778 Status Allocation Service Midlothian IJB Annual Budget '000 Midlothian IJB YTD Budget £'000 Delegated Core Community Equipment 607 551 Community Hospitals 6,473 3,299 Community Nursing 2,603 1,301 Complex Care 0 0 Diabetes & Endocrinology 21 21 District Nursing 6,040 3,242 Geriatric Medicine 1,322 584 GMS 18,361 9,334 Health Visiting 2,566 1,297 Mental Health 2,871 1,419 ML Partnership Directorate (61) 139 ML Partnership Management 671 317 ML Strategic Investment (713) (25) Other 49 (223) Partnership Directorate 0 0 PC Management 3,518 (489) PC Services 1,066 395 Pharmacy 137 1 Prescribing 19,984 9,846 Reserves 0 0 Resource Transfer 6,973 3,471 Substance Misuse 197 99 Therapy Services 2,600 897 Core Total 75,285 35,477 Corporate Non Consolidated Payment for AfC 598 598 Corporate Total 598 598 Hosted Community Hospitals 82 86 Midlothian IJB - M06 YTD 23/24 - Financial Statement Midlothian IJB - M06 YTD 23/24 - Financial Statement Page 95 of 348
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Complex Care 174 82 Diabetes & Endocrinology 4 2 Geriatric Medicine 0 0 GMS 1,373 483 Hospices & Palliative Care 521 261 Learning Disabilities 1,430 669 LUCS 1,341 588 Mental Health 2,968 1,550 Oral Health Services 949 320 Outpatients 15 15 PC Services 663 335 Pharmacy 58 6 Prescribing (362) (82) Psychology Services 1,587 673 Public Health 206 70 Rehabilitation Medicine 1,005 479 Sexual Health 858 391 Strategic Services 0 0 Substance Misuse 592 272 Therapy Services 1,666 851 UNPAC 662 251 Hosted Total 15,790 7,301 Delegated Total 91,674 43,376 Set Aside Acute Acute Management 662 361 Cardiology 777 384 Children Therapies 20 12 Diabetes & Endocrinology 524 206 ED & Minor Injuries 3,202 1,562 Gastroenterology 1,751 858 General Medicine 6,460 3,196 Geriatric Medicine 3,275 1,627 Infectious Disease 629 (41) Junior Medical 590 269 Outpatients 129 62 Rehabilitation Medicine 346 172 Respiratory Medicine 1,376 716 Therapy Services 1,905 1,019 Acute Total 21,645 10,403 Set Aside Total 21,645 10,403 Grand Total 113,319 53,778 Page 96 of 348
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Midlothian IJB YTD Actual £'000 Midlothian IJB YTD Variance £'000 Midlothian IJB M06 23/24 Forecast Variance £'000 36,533 (1,056) (1,876) 599 (1) (1) 7,148 153 322 11,209 (806) (1,615) 55,489 (1,711) (3,170) Midlothian IJB YTD Actual £'000 Midlothian IJB YTD Variance £'000 Midlothian IJB M06 23/24 Forecast Variance £'000 551 0 100 3,439 (141) (320) 1,456 (155) (310) 12 (12) (12) 21 0 0 3,121 121 340 471 113 226 9,407 (74) (154) 1,362 (65) (128) 1,329 90 190 141 (2) 56 294 22 104 (25) 0 (0) (193) (30) (61) 0 (0) (0) (237) (252) (361) 403 (8) (21) (0) 2 0 10,648 (803) (1,656) 0 0 0 3,458 13 (0) 98 0 (12) 776 122 142 36,533 (1,056) (1,876) 599 (1) (1) 599 (1) (1) 83 3 (0) Midlothian IJB - M06 YTD 23/24 - Financial Statement Midlothian IJB - M06 YTD 23/24 - Financial Statement Page 97 of 348
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74 8 14 1 1 1 1 (1) (2) 496 (13) (72) 261 (0) (2) 683 (14) 1 591 (2) (4) 1,586 (36) (36) 313 7 17 18 (3) (21) 353 (17) (75) 6 (0) 0 12 (94) (107) 552 121 268 63 7 5 412 67 130 393 (1) (6) 0 0 0 255 17 15 820 31 69 176 74 125 7,148 153 322 44,280 (905) (1,555) 353 9 (6) 382 3 14 10 1 (1) 278 (73) (152) 1,756 (194) (415) 977 (119) (296) 3,351 (155) (381) 1,708 (81) (165) (69) 28 11 340 (71) 0 54 8 1 188 (16) (43) 786 (71) (77) 1,094 (75) (106) 11,209 (806) (1,615) 11,209 (806) (1,615) 55,489 (1,711) (3,170) Page 98 of 348
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Health and Social Care Adult Social Care - Delegated to IJB 2023-24 Quarter 2 Projected Revised Quarter 2 (Underspend) Budget Projection Overspend SERVICE FUNCTION Older People Older People 25,742,587 28,041,605 2,299,018 Sub-total Older People 25,742,587 28,041,605 2,299,018 Adults Addictions 32,230 113,533 81,303 Justice 37,380 (2,620) (40,000) Learning Disability Services 18,385,539 21,571,795 3,186,256 Meldap/Recovery Hub 239,628 300,177 60,550 Mental Health Services 1,134,041 1,022,141 (111,900) Non Specific Groups 1,102,898 1,117,480 14,583 People with AIDS/HIV (32,778) (32,780) (2) Physical Disability Services 3,829,016 4,110,094 281,078 Public Protection 768,814 446,415 (322,399) Sub-total Adults 25,496,768 28,646,235 3,149,467 Other Assessment & Care Management 3,970,057 3,852,724 (117,334) Learning & Development 665,318 664,985 (333) Performance 69,522 83,034 13,512 Service Management 478,736 645,222 166,486 Strategic Commissioning 115,639 16,938 (98,701) Sub-total Other 5,299,271 5,262,902 (36,369) Provision for additional 0.5% pay award 0 100,000 100,000 NET EXPENDITURE 56,538,626 62,050,743 5,512,116 Page 99 of 348
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Midlothian Integration Joint Board Thursday 21st December 2023, 14:00-16:00 Integration Joint Board Scheme of Publication Executive summary The Midlothian Integration Joint Board (IJB) is required to produce a Publication Scheme under The Freedom of Information (Scotland) Act 2002 (the Act). The Act requires Scottish public authorities to provide members of the public with the information that is held by the IJB, and to produce and maintain a publication scheme. Integration Authorities are under a legal obligation to publish the classes of information that they routinely make available, how this information can be accessed, and whether information is available free of charge or on payment. Midlothian IJB adopted the Model Publication Scheme produced and approved by the Scottish Information Commissioner in 2017. The requirements of the Model Publication Scheme were updated by the Scottish Information Commissioner’s Office (ICO) in 2021. The Midlothian IJB Publication Scheme 2023 ‘Guide to Information’ is an update and reworking of the Midlothian IJB Scheme of Publication. This update brings the publication scheme in line with the revised Scottish Information Commissioner Model Publication Scheme. The document supports Midlothian IJB to meet other relevant statutory obligations such as the Freedom of Information (Scotland) Act 2002 and Equality Act 2010/Public Sector Equality Duties. The Midlothian IJB Audit and Risk Committee review the proposed Publication Scheme 2023 ‘Guide to Information’ alongside a completed Equality and Children’s Right Impact Assessment on Thursday 7th December and recommended this to the Board for approval. Members are asked to: • Review the proposed Midlothian IJB Scheme of Publication and accompanying Equality and Children's Right Impact Assessment, • Note the recommended actions resulting from the Impact Assessment, • Agree to adopt the proposed Midlothian IJB Scheme of Publication, and • Grant delegated authority to the Integration Manager to inform the Scottish Information Commissioner Item number: 5.6 Page 101 of 348
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Midlothian Integration Joint Board Midlothian Integration Joint Board Integration Joint Board Scheme of Publication 1 Purpose 1.1 The purpose of the report is to seek agreement from Midlothian Integration Joint Board to adopt the reviewed and updated Scheme of Publication in line with the Scottish Information Commissioner Model Publication Scheme (appendix 1). 2 Recommendations 2.1 As a result of this report, Members are asked to: • Review the updated information within the Scheme of Publication, • Review the accompanying Equality and Children's Right Impact Assessment, • Note the recommended actions resulting from the Impact Assessment, • Consider updates and approve amendments for recommendation to Midlothian IJB. 3 Background and main report 3.1 Midlothian IJB currently have a Scheme of Publication (2019), this requires to be reviewed and updated in line with updated Scottish Information Commissioner Model Publication Scheme, and for compliance with Freedom of Information (Scotland) Act 2022 and Equality Act 2010. 3.2 The Scheme of Publication outlines the information which the IJB pledges to ensure is routinely available, such as minutes of meetings, annual reports, and financial information. It also details whether information is available free of charge or on payment. 3.3 Midlothian IJB first adopted the Scottish Information Commissioner’s Model Publication Scheme on 31st May 2017. The Model Publication Scheme was updated in 2018 and again in 2021. However, pressures experienced across health and social care from March 2020 resulted in some statutory governance requirements being paused or extension for completion. Midlothian IJB completed a comprehensive review of governance requirements in 2023 and agreed a programme of work including the review of the Model Publication Scheme. 3.4 Changes to previous Scheme of Publication are as follows: • Midlothian IJB Publication Scheme 2023 has been renamed (addition of plain English sub heading ‘Guide to Information’) and adjusted to satisfy the requirements of the ICO’s Model Publication Scheme 2021 and appeal more Page 102 of 348
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Midlothian Integration Joint Board to the public. Language has been adjusted, where possible without straying from ICO Model Publication Scheme 2021, to be clear about what the Publication Scheme is, who it is for and what rights people have to access the information that is signposted. • In a change from Midlothian IJB publication scheme 2019, costs for alternative formats have been removed in agreement with Midlothian Council as Midlothian IJBs records management partner. 3.5 The Midlothian IJB Audit and Risk Committee review this revised Scheme of Publication on Thursday 7th December 2023 and recommended it to the Board for approval. 4 Policy Implications 4.1 Freedom of Information law requires authorities to publish information as well as respond to requests. They must make information available to the public so that it can be accessed without having to ask for it. Integration Authorities must adopt a publication scheme approved by the Scottish Information Commissioner. 5 Directions 5.1 There are no direct implications for Directions in relation to this report. 6 Equalities Implications 6.1 The Scheme of Publication complies with the Public Sector Equality Duty under the Equality Act 2010 to take steps to meet the needs of people who share a relevant protected characteristic. In terms of access to information, this means making reasonable adjustments to our practices to ensure that information is accessible to all who may be living with an impairment. The Scheme of Publication outlines the various formats information will be available, i.e., alternative formats and languages. 6.2 An Equality and Children’s Rights Impact Assessment has been completed for review (appendix 2). 7 Resource Implications 7.1 There are no direct implications for Midlothian IJB and resource in relation to this report. Page 103 of 348
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Midlothian Integration Joint Board 8 Risk 8.1 The Act is designed to increase transparency. Members of the public should be able to routinely access information that is in the public interest and is safe to disclose. 8.2 Also, without the publication scheme, members of the public may not know what information public authorities have available. A routinely reviewed and revised publication scheme ensures mitigation in terms of reputational risk as well as compliance with statutory obligations. 9 Involving people 9.1 Review of the Publication Scheme has involved consultation and collaboration across Midlothian Health and Social Care. This has included the Public Involvement Officer, Equalities and Human Rights Lead, Integration Manager, members of the SPG and Midlothian IJB. 10 Background Papers 10.1 N/a. AUTHOR’S NAME AND DESIGNATION Gill Main, Integration Manager Lisa Cumming, Business Support Manager CONTACT INFO Via email or MS Teams DATE 07/12/2023 Appendices: Appendix 1: MIJB Scheme of Publication V2 Appendix 2: Scheme of Publication Equality and Children's Right Impact Assessment Appendix 3: Equality and Children's Rights Impact Assessment Guidance Page 104 of 348
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November 2023 Midlothian Integration Joint Board Publication Scheme ‘Guide to Information’ The Scottish Commissioners Office and Freedom of Information (Scotland) Act 2002 places a duty on us to publish information which everyone has the right to access. We have adopted the Commissioner’s Model Publication Scheme to let people know • The types of information that we publish or will publish • How the information is published or will be published. • Whether there is a charge for the information. Availability, Formats and Charges We publish our information online at www.midlothian.gov.uk/mid-hscp . If you need something in another format let us know we can provide this for free. Advice and Assistance If you would like more information about what we publish, to ask for information in another format or to ask for information that is not published on our website please contact us at: Midlothian Integration Joint Board, Fairfield House, 8 Lothian Road, Dalkeith, EH22 3ZH e-mail: contactcentre@midlothian.gov.uk Tel: 0131 270 7500 Duration Once published, information will be available for the current and previous two financial years. If we update information only the current version will be available but you can ask for previous versions. Exempt Information If we cannot publish something or it is exempt under Scotland’s freedom of information laws (for example sensitive personal data), we may withhold the information or provide a redacted version and explain why we have done so. Copyright and Re-use Where we hold copyright in our published information, the information may be copied or reproduced without formal permission provided that: • It is copied or reproduced accurately; • It is not used in a misleading context; and • The source of the material is identified. Where we do not hold the copyright in information we publish, we will make this clear. Page 105 of 348
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November 2023 The types of Information we publish There are nine types of information we must publish, if we hold information of that type: Class 1 - Information about the IJB Information about us, who we are, where to find us, how to contact us, how we are managed and our external relations. Information about the IJB Class 2 – How we deliver our functions and services Information about our work, our strategy and policies for delivering functions and services and information for our services users. Our Strategic Plan Class 3 – How we take decisions and what we have decided Information about the decision we take, how we make decisions and how we involve others. Decisions, including minutes of the Board and sub-committee meetings Class 4 - What we spend and how we spend it Information about our strategy for, and management of, financial resources (to explain how we plan to spend public money and what has been spent). Details of our spending (when available) Class 5 - How we manage our human, physical and information resources The services we commission are delivered by Midlothian Council and NHS Lothian. We do not hold any information within this class. Class 6 – How we procure goods and services from external providers. The services we commission are delivered by Midlothian Council and NHS Lothian. We do not hold any information within this class. Class 7 - How we are performing Information about how we perform as an organisation, and how well we deliver our functions and services. IJB Performance reports Class 8: Our commercial publications. Information packaged and made available for sale on a commercial basis and sold at market value through a retail outlet e.g, bookshop, museum or research journal. We do not create information within this class. Class 9 – Our open data Open data made available as described by the Scottish Government’s Open Data Resource Pack and available under an open license. It is our aim to make increasing amounts of our data freely and widely available online. We have adopted the UK Government’s approach to Open Data Standards in that data should be published to a minimum of 3 stars in the Government’s 5 star rating scheme. This means our data is easily accessible and available to re-use as required under the Open Government License Page 106 of 348
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1 Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report Midlothian Integrated Joint Board Publication Scheme 2023 Page 107 of 348
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2 Contents Brief description of proposed work ........ Error! Bookmark not defined. Evidence ................................................................................. 5 Impact on equality & socio-economic disadvantage .............. 6 Impact on UNCRC rights ....................................................... 15 Making a difference .............................................................. 22 Monitoring the actual impact ............................................... 20 Sharing with decision-makers ............................................... 20 Page 108 of 348
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3 Description Guidance pages 4-7 Title of proposed work and name of contracted organisation Midlothian Integration Joint Board Publication Scheme 2023 ‘Guide to Information’. Purpose/ objective of proposal The Midlothian Integration Joint Board (IJB) is required to provide the public with a Publication Scheme under the Freedom of Information (Scotland) Act 2002 (the Act). The Act requires Scottish public authorities to make available specific types of information that it holds. Authorities are under a legal obligation to publish the classes of information that they make available, tell the public how to access the information, and whether information is available free of charge or for a fee. The Midlothian IJB have adopted the Model Publication Scheme (2021) produced and approved by the Scottish Information Commissioner. The requirements of the Model Publication Scheme were updated by the Information Commissioner’s Office (ICO) in 2021. Midlothian IJB Publication Scheme 2023 ‘Guide to Information’ is an update and reworking of the Midlothian IJB Scheme of Publication (2019). This update brings the publication scheme in line with the ICO Model Publication Scheme (2021). The document supports Midlothian IJB to meet other relevant statutory obligations such as the Freedom of Information (Scotland) Act 2002 and Equality Act 2010/Public Sector Equality Duties. Who will be affected by this proposal The Midlothian IJB Publication Scheme 2023 will affect the general public through providing information to them about which types of information they can access, the location of the information and by informing them that they can request the information in a format that meets their needs. The Midlothian IJB Publication Scheme 2023 has potential to disproportionately affect people with sensory or cognitive impairment, learning difficulties, lower levels of literacy and British Sign Language users. Midlothian IJB has taken extra care to consider people from these groups to ensure that everyone can access information in a way that they can digest. Some people with these needs are protected by the Equality Act 2010, under the protected characteristic of disability. Others may not be covered under the legal definition of being disabled, but have been given the same consideration by Midlothian IJB, with a view that legal requirements are one part of a holistic approach that values the needs of everyone as a moral imperative as well as statutory one. Page 109 of 348
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4 Reported written by Lisa Cumming Business Support Manager, Midlothian HSCP Guidance and additional perspectives Kate Thornback Equality and Human Rights Lead, Midlothian HSCP Caroline Shilton Public Engagement Officer, Midlothian HSCP Report authorised by (and date) Gill Main Integration Manager, Midlothian HSCP Date: 07/12/2023 Page 110 of 348
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5 Evidence Guidance pages 8-9 & 18-22 Evidence used: The publication scheme which preceded this review, MIJB Scheme of Publication 2019, was made available to the public on the Midlothian IJB website. As the document was freely available to the public, it was not possible to collect data on those that accessed the document. Given the absence of data related to people that accessed the former publication scheme, it is not possible to deduce which specific individuals accessed the document and the needs that they had. To ensure that access for a broad set of needs is actively considered in the Midlothian IJB Publication Scheme 2023, Midlothian IJB has gathered data on the population of Midlothian via the Midlothian HSCP Physical Disability and Sensory Impairment Data and the National Records of Scotland to help identify those likely to be most affected. Conversations with the Equality and Human Rights Lead and those working within accessibility and communications within Midlothian Health and Social Care suggested that the Midlothian IJB Publication Scheme 2023 has potential to disproportionately affect people with: Sensory impairment – The most likely sensory impairment that will affect people’s reading of the Midlothian IJB Publication Scheme 2023 and the information it signposts to is vision impairment, blindness/partial sight, or sight loss. Less severe forms of vision impairment are very common with more severe forms of vision impairment occurring in about 3% of the UK population. Sight loss is disproportionately experienced my those in older age groups. The National Record of Statistics Scotland Population Projection by Council area recorded the largest percentage increase of the 75 year and over age group in Midlothian between 2001 and 2021 of +49.5%. British Sign Language Users also experience sensory impairment but have different needs than those that are deaf, have partial hearing or experience hearing loss and do not use British Sign Language, so British Sign Language users have been noted separately. Cognitive impairment – Cognitive impairment can affect people from birth, develop as they age or happen as a result of injury or illness. It can also be linked with conditions such as Dementia and Alzheimer's which disproportionately affect those in older age groups. It can be temporary or long term. It can affect the way people process information, their memory, ability to focus and other have other impacts on ability to understanding information. Learning difficulties – Midlothian Health & Social Care Partnership Consultation Report for Strategic Plan 2022-2025 estimates 1,722 people have a learning difficulty within Midlothian. There are different kinds of learning difficulties and a number of different ways to assist people with learning difficulties to access information, such as adopting a plain English and Easy Read format. Page 111 of 348
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6 Lower levels of literacy - A survey carried out by Adult National Literacy Trust says that 1 in 4 adults in Scotland experience challenges with lower levels of literacy skills. People do not reach adult levels of literacy for a variety of complex social and personal reasons. Some of these reasons link to social disadvantage, lack of opportunity and poverty. It is important that people with lower levels of literacy are considered when presenting information and that language use is mindful of lower literacy levels. British Sign Language users – Scotland’s census (2022) identified 233 people within Midlothian who were British Sign Language users. British Sign Language users are people that have learned British Sign Language (in its visual or tactile form) as a method of communication. Most British Sign Language users are deaf or hearing impaired. Users may use British Sign Language alongside other forms of communication, or they may use British Sign Language exclusively. It is important not to assume that British Sign Language users read the written word, and instead endeavour to provide information in British Sign Language wherever possible. The British Sign Language Act 2015 sets out requirements on public authorities to plan for and promote British Sign Language. Older people, in relation to their likelihood to belong to another protected characteristic group – Those in older age groups have a higher level of sensory and cognitive impairment that other age groups. Given National Record of Statistics Scotland’s figures on the increase in the 75 years and over age group in Midlothian, in the last two decades (+49.5%), recognising the needs of this group will be crucial in preventing indirect discrimination. Summary of findings: The Midlothian IJB Publication Scheme 2023 is an important public document that helps people to understand their right to publicly held information. As far as possible (without departing from the ICO Model Publication Scheme 2021) the document should be put together in a way that suits a general audience but is also adapted to and mindful of the needs of people with a variety of different access needs. Providing a range of formats and language options helps to remove barriers to access and increases community understanding of health and social care. In practice this means: • Writing the document, wherever possible whilst maintaining compliance with ICO Model Publication Scheme 2021, in plain English – advice has been sought from the ICO and a response received in November 2023 that outlines which phrases can and cannot be changed. • Ensuring formatting of the document is suitable for assistive technologies such as screen readers, text to speech, Google translate. • Creating an Easy Read version for those with cognitive and learning difficulties. This may appeal to some with lower literacy levels also. • On request, translating the document into other languages (either digitally through a translation programme, or via official translation) and be provided in a format which is most accessible to the individual. Page 112 of 348
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7 • On request, creating a British Sign Language (visual) translation to accompany the document online. • Seeking out and listen to feedback from the community on how IJB efforts to produce accessible information has been in practice and take action to address any barriers to access raised during the life of the Midlothian IJB Publication Scheme 2023. Page 113 of 348
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 8 Impact on equality & socio-economic disadvantage Guidance p10-16 Negative impacts Using the evidence you have collected, explain if your proposal could be discriminatory or put a group of people at a disadvantage. Some work will be broad and affect everyone working for us or using our services, but some may only affect specific groups of people. If this is the case, simply say ‘not relevant’ or ‘no known relevance’ if your proposal does not affect a group. Relevant group Could your work result in unlawful discrimination? Could your work put people at a disadvantage/ make their lives worse? People in different age groups No. Thoughtfully setting out the document to work with assistive technologies and providing a range of alternative formats to meet the needs of older people that have sensory, cognitive impairment or another protected characteristic will eliminate unlawful discrimination. No. Disabled people No. Thoughtfully setting out the document to work with assistive technologies and providing a range of alternative formats to meet the needs of disabled people will eliminate unlawful discrimination. British Sign Language translation of this document should be undertaken. No. Page 114 of 348
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 9 Relevant group Could your work result in unlawful discrimination? Could your work put people at a disadvantage/ make their lives worse? Trans and non-binary people Not relevant Information will be made available to all enquirers in the same way. Not relevant Information will be made available to all enquirers in the same way. People who are pregnant or on maternity leave Not relevant Information will be made available to all enquirers in the same way. Not relevant Information will be made available to all enquirers in the same way. People from different ethnic backgrounds Indirectly, yes. People from different ethnic backgrounds that struggle with reading written English may be prevented from accessing information, and thus exercising their rights to read the information if translation was not thoughtfully advertised e.g. a simple sentence in the most common languages other than English spoken in Midlothian explaining that translations of documents can be requested, or how to use technology to translate documents. No, provided that invitations to request the Midlothian IJB Publication Scheme 2023 scheme is translated/digitally translatable into the most common languages other than English spoken in Midlothian. Page 115 of 348
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 10 Relevant group Could your work result in unlawful discrimination? Could your work put people at a disadvantage/ make their lives worse? People with religious or protected beliefs Not relevant Information will be made available to all enquirers in the same way. Not relevant Information will be made available to all enquirers in the same way. Men and women Not relevant Information will be made available to all enquirers in the same way. Not relevant Information will be made available to all enquirers in the same way. People who are heterosexual, lesbian, gay or bisexual Not relevant Information will be made available to all enquirers in the same way. Not relevant Information will be made available to all enquirers in the same way. People who are married or in a civil partnership [only in employment situations] Not relevant Information will be made available to all enquirers in the same way. Not relevant Information will be made available to all enquirers in the same way. Care experienced people Note from the form author: This box should not be completed because there is no protection from discrimination on basis of care experience. Not relevant Information will be made available to all enquirers in the same way. Page 116 of 348
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 11 Relevant group Could your work result in unlawful discrimination? Could your work put people at a disadvantage/ make their lives worse? People experiencing health inequalities caused by socio- economic disadvantage Note from the form author: This box should not be completed because there is no protection from discrimination on basis of socio-economic disadvantage. No. People experiencing employment inequalities caused by socio-economic disadvantage Note from form author: This box should not be completed because there is no protection from discrimination in employment on basis of socio-economic disadvantage. Not relevant Information will be made available to all enquirers in the same way. Carers Note from form author: This box should not be completed because there is no protection from discrimination on basis of caring responsibilities. Carers of people with cognitive impairment, learning difficulties and sensory impairment may wish to access a version to suit the needs of the person for which they care so that person can understand their rights and participate in health and social care decision making. If alternate versions were not provided, this could make the carer’s role as an advocate for the person for which they care more difficult. Positive impact Using the evidence you have collected, explain if and how your proposal could have a positive impact on reducing inequalities facing different groups. Some work will be broad and affect everyone working for us or using our services, but some may only affect specific groups of people. If this is the case, say ‘not relevant’ or ‘no known relevance’ if your proposal does not affect a group. Page 117 of 348
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 12 Relevant group Can your work advance equality of opportunity? [reduce disadvantage, meet needs, increase participation] Can your work foster good relations? [reduce prejudice + increase tolerance] People in different age groups The Midlothian IJB Publication Scheme 2023 will assist people in all age groups, but especially the young, to understand their rights which could increase participation and reduce disadvantage. The availability of different formats (large font, easy read) will assist those in older age groups to be able to participate more easier in discussions and decision making in health and social care. The Midlothian IJB Publication Scheme 2023 could foster good relations between the IJB and people of all ages, improving mutual understanding. Disabled people The Midlothian IJB Publication Scheme 2023 will assist in increasing access and participation through enabling those with disabilities to access versions in a format that meets their needs. Participation in health and social care by these groups may reduce disadvantage over time, by ensuring their voices are heard during decision making. Providing information in accessible formats fosters good relations by demonstrating IJB respect for the public and their diverse needs. This may boost good will and mutual understanding and reduce prejudice by breaking down assumptions and stereotypes. Trans and non-binary people Not relevant Information will be made available to all enquirers in the same way. Not relevant Information will be made available to all enquirers in the same way. People who are pregnant or on maternity leave Not relevant Information will be made available to all enquirers in the same way. Not relevant Information will be made available to all enquirers in the same way. Page 118 of 348
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 13 Relevant group Can your work advance equality of opportunity? [reduce disadvantage, meet needs, increase participation] Can your work foster good relations? [reduce prejudice + increase tolerance] People from different ethnic backgrounds It is possible this work will reduce disadvantage by enabling those from difference language backgrounds to engage in health and social care. Documents can be made available in different languages at the enquirer’s request People with religious or protected beliefs Not relevant Information will be made available to all enquirers in the same way. Not relevant Information will be made available to all enquirers in the same way. Men or women Not relevant Information will be made available to all enquirers in the same way. Not relevant Information will be made available to all enquirers in the same way. People who are heterosexual, lesbian, gay or bisexual Not relevant Information will be made available to all enquirers in the same way. Not relevant Information will be made available to all enquirers in the same way. Care experienced people Not relevant Information will be made available to all enquirers in the same way. Not relevant Information will be made available to all enquirers in the same way. People who experience health inequalities caused by socio-economic disadvantage Eliminating costs on alternative formats may improve access to information to those on low incomes that require alternative formats, boosting their understanding of their rights, their participation and their voice in decision making. Not relevant. Page 119 of 348
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 14 Relevant group Can your work advance equality of opportunity? [reduce disadvantage, meet needs, increase participation] Can your work foster good relations? [reduce prejudice + increase tolerance] People who experience employment inequalities caused by socio-economic disadavantage Not relevant Information will be made available to all enquirers in the same way. Not relevant Information will be made available to all enquirers in the same way. Carers Not relevant Information will be made available to all enquirers in the same way. Not relevant Information will be made available to all enquirers in the same way. Page 120 of 348
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 15 Impact on UNCRC rights Guidance pages 17, 21-22 Confirm whether your proposal affects children and young people (yes or no). If yes, using the evidence you have collected explain how your proposal could impact Children’s Rights. Not all UNCRC rights may apply to your proposal. If this is the case, simply say ‘Not relevant’ or ‘no known relevance’. If your proposal does not affect children and young people do not complete this section. UNCRC right How will your work limit or restrict this right? How will your work progress this right? Are any groups of children particularly impacted 3 – best interests of the child Not relevant Not relevant Not relevant 4. making rights real Not relevant The Midlothian IJB Publication Scheme 2023 could improve access to information, understanding of rights and participation in health and social care for teenagers. Not relevant 5 – family guidance as children develop Not relevant Not relevant Not relevant 6 – life, survival and development Not relevant Not relevant Not relevant Page 121 of 348
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 16 UNCRC right How will your work limit or restrict this right? How will your work progress this right? Are any groups of children particularly impacted 7 – name and nationality Not relevant 8 – identity Not relevant 9 – keeping families together Not relevant 10 - contact with parents across countries Not relevant 11 – protection from kidnapping Not relevant 12 – respect for children’s views Not relevant Page 122 of 348
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 17 UNCRC right How will your work limit or restrict this right? How will your work progress this right? Are any groups of children particularly impacted 13 – sharing thoughts freely 14 – freedom of thought and religion 15 –freedom of association and peaceful assembly 16 – protection of privacy 17 – access to information The Midlothian IJB Publication Scheme 2023 could improve access to information, understanding of rights and participation in health and social care for teenagers. 18 – responsibility of parents Page 123 of 348
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 18 UNCRC right How will your work limit or restrict this right? How will your work progress this right? Are any groups of children particularly impacted 19 – protection from violence 20 – children without families 21 – children who are adopted 22 – refugee children 23 – disabled children 24 – enjoyment of the highest attainable standard of health The Midlothian IJB Publication Scheme 2023 could improve access to information, understanding of rights and participation in health and social care for teenagers. This could enable a generation of young people to feel Page 124 of 348
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 19 UNCRC right How will your work limit or restrict this right? How will your work progress this right? Are any groups of children particularly impacted empowered to influence their own health and social care and get involved in decision making. 25 – review of a child’s placement 26 – social and economic help 27 – food, clothing and safe home 28 – access to education 29 – aims of education Page 125 of 348
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 20 UNCRC right How will your work limit or restrict this right? How will your work progress this right? Are any groups of children particularly impacted 30 – minority culture, language and religion 31 – rest, play, culture, arts 32 – protection from harmful work 33 – protection from harmful drugs 34 – protection from sexual abuse 35 – prevention of sale and trafficking Page 126 of 348
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 21 UNCRC right How will your work limit or restrict this right? How will your work progress this right? Are any groups of children particularly impacted 36 – protection from exploitation 37 – children in detention 38 – protection in war 39 – recovery and reintegration Page 127 of 348
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 22 Making a difference Guidance pages 11 & 15 What changes will you make to your proposal based on the results of this impact assessment? Changes What difference this will make Midlothian IJB Publication Scheme 2023 has been renamed (addition of plain English sub heading ‘Guide to Information’) and adjusted to satisfy the requirements of the ICO’s Model Publication Scheme 2021 and appeal more to the public. Language has been adjusted, where possible without straying from ICO Model Publication Scheme 2021, to be clear about what the Publication Scheme is, who it is for and what rights people have to access the information that is signposted. This approach is a plain English approach, and best practice for all public facing documentation. The Midlothian IJB Publication Scheme 2023 should be better understood by a broader range of people than the 2019 version. This may help people to understand their right to information and participation in health and social care, allowing the public to engage with and shape services and strategy, and to make more informed choices in their own care. The new approach helps to include those with less proficient literacy and learning difficulties. The Midlothian IJB Publication Scheme 2023 will be formatted in a way that works with assistive technologies. The Public Engagement Officer will discuss how best to highlight that this has been done to the public (e.g. adding a statement on the webpages that links to the document). Those that use assistive technologies to read information on a screen will be able to read all information in the document, improving their access. The Midlothian IJB Publication Scheme will translate the line in the document that mentions that the documents signposted can be translated into any languages other than English that are statistically known to be spoken in Midlothian. This will help those that could benefit from translations, including those from black and ethnic minority backgrounds (some of which are protected under Equality Act 2010 under race) to understand their rights to access information and to participation in health and social care decision making. In a change from Midlothian IJB publication scheme 2019, costs for alternative formats have been removed. Removing charges ensure everyone can access formats that meet their needs. It particularly assists in the protection of the rights of people who experience inequalities caused by socio-economic Page 128 of 348
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 23 Changes What difference this will make disadvantage/low income from being prevented or discouraged from requesting information in the formats that suit their needs. An easy read version should be produced to satisfy the needs of a range of people covered under Equality Act 2010 (protected characteristic: disability) and others not covered under that definition, but who could benefit from a more concise, more visual presentation. An easy read version may assist people with visual and cognitive impairment, learning difficulties and lower literacy to understand the Publication Scheme document and the information that they can access through the IJB. The Midlothian IJB Publication Scheme 2023 should be recorded in British Sign Language (visual) and the video posted alongside the written version. This recognises British Sign Language as a language and respects it may be some people’s primary/only language. It allows users to better understand their rights to participate with health and social care decision making. After consideration and approval at IJB senior meetings, this IIA will be published online for public view. In order that the IIA be readable to the greatest number of people, the content will be adjusted to plain English. This is to ensure that people that are interested in understanding IJB consideration for access can understand the content of the IIA in lay terms. Page 129 of 348
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 24 Sharing with decision-makers Guidance page 23 Explain how you will make sure the results of your impact assessment will be taken into account by decision-makers before a final decision is taken. This IIA will be presented to the Integration Manager, for consideration and reflection. The Integration Manager will take the IIA and present it to the IJB. These documents will also be discussed at the IJB Audit & Risk Committee. Midlothian Health and Social Care’s Equality and Human Rights Lead will work with the Integration Manager to answer any questions that arise from the IIA entering the IJB and Audit and Risk Committee and will create a plan to implement all agreed recommendations. Monitoring the impact Guidance page 24 How will you monitor the actual impact of this piece of work on equality, socio-economic disadvantage or children’s rights? Performance Indicator for equality, socio-economic disadvantage and children’s rights. What impact are you measuring Community representatives/third sector partner organisations will be asked for feedback or to test whether the wording and format/s are suitable for the people that they represent. The Equality and Human Rights Lead will collate responses, make changes or escalate to senior committees as necessary. Readability and access for: Vision impaired. Cognitive impaired. People with learning difficulties. Lower levels of literacy. People in older age groups. The Midlothian Health Inclusion Team will be consulted to check that wording and format/s are suitable for the people that use their services. The Equality and Human Rights Lead will collate responses, make changes or escalate to senior committees as necessary. Readability and access for: People experiencing homelessness or other situations that lead to a complex living situation. Page 130 of 348
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 25 People experiencing drug and alcohol misuse issues. People belonging to the Gypsy/Roma/Traveller community. Any feedback received from the public regarding the IJB Publication Scheme 2023 will be collated and evaluated by the Equality and Human Rights Lead, and actions/escalation taken where needed. Readability and access for anyone that is interested to see the information and had encountered a barrier not identified in this IIA. Page 131 of 348
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Equality. Fairer Scotland. Children’s Rights Impact Assessment Guidance 1 Equality. Fairer Scotland. Children’s Rights Impact Assessment Guidance Healthy and better lives for everyone Page 133 of 348
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Equality. Fairer Scotland. Children’s Rights Impact Assessment Guidance 2 Contents Introduction .................................................................. 3 Do you need an Impact Assessment? ........................... 4 1 Planning the process .................................................. 7 2 Collecting the evidence .............................................. 8 3 Assessing the impact ................................................ 10 4 Sharing with decision makers .................................. 23 5 Publishing your results ............................................. 24 6 Monitoring the impact ............................................. 24 Page 134 of 348
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Equality. Fairer Scotland. Children’s Rights Impact Assessment Guidance 3 Introduction Impact Assessments help us make good decisions. They make sure our work doesn’t have a negative impact on anyone. They also help us to find ways to make our work have a positive impact on people because we have checked and developed our proposals so they: • Do not result in unlawful discrimination. • Help to tackle inequalities and achieve greater equality for people experiencing disadvantage or with different needs. • Uphold and progress children and young people’s rights. An Impact Assessment should be done at the beginning of your project to allow you time to take the results into account. Use this guide as you complete your Impact Assessment to ensure you comply with our legal responsibilities and policies to help you: 1. Plan this process. 2. Collect evidence. 3. Assess the impact of your work and take your findings into account. 4. Share your assessment with decision makers. 5. Publish your assessment. 6. Monitor the impact of your work. If you want to also consider the impact of your work on climate change and sustainability contact sustainability@nhslothian.scot.nhs.uk Page 135 of 348
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Equality. Fairer Scotland. Children’s Rights Impact Assessment Guidance 4 Do you need an Impact Assessment? Impact Assessments are not optional. The Equality and Fairer Scotland duties set out our legal responsibilities to assess the impact of policies or practices before we implement them. Legislation is expected to come into force in 2024 that will require us to ensure we are protecting children’s rights when we are making decisions and delivering services. As most of our work has consequences for people, we normally expect Impact Assessments to be carried out. However, there may be occasions when we do not need to do one. This guidance will help you to decide and if, after reading this, you feel you don’t need to carry out an Impact Assessment record your decision on this template. In some cases, it will be clear that the equality duties and children’s rights have no relevance to a particular bit of work. However, if there is any doubt the issue should be explored – this should be more than guesswork but should not be burdensome. If you are unsure get in touch with the Equality and Human Rights Team at impactassessments@nhslothian.scot.nhs.uk. You DO need an assessment for work that will impact people e.g.: • Strategies • Projects • Employment policies and practices • Service or organisational redesign • Financial decisions Example A policy on home working or the closure of a care home. You DO NOT need an assessment for work that won’t affect people e.g.: • Progress, performance or research reports • Press releases • Creation of one new post • Audit of financial accounts Example A progress report on meeting our office waste recycling targets or presentation about the findings of a research project. Page 136 of 348
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Equality. Fairer Scotland. Children’s Rights Impact Assessment Guidance 5 Level of Impact Assessment needed Any Impact Assessment should be proportional to the impact of the proposed work. The time and resources you spend on the Impact Assessment will depend on your proposal. You will need to consider if your work is: • Major – in terms of scale or significance • Minor – but likely to have a major impact on people who share relevant protected characteristics • Minor – in terms of scale or significance. Services delivered on our behalf We cannot delegate our legal responsibilities. If we contract with another organisation to carry out one of our public functions, and an Impact Assessment must be done as part of the work, we must ensure the requirement to carry out an Impact Assessment is included in the contract specifications. Example NHS Lothian contracts an external organisation to support people with frailty. The Service Level Agreement we create includes ‘equality considerations and requirements’ that the contractor must meet. This includes carrying out an impact assessment and using the results to develop the proposals about how they will provide this support. This helped the contractor identify when and how to use interpreters, including BSL, and the need to produce written information in plain English, large font and EasyRead. Implementing national policy or initiatives Although national Impact Assessments will already have been completed for national policies or initiatives, we must assess the potential impact on people who use our services or who work for us. Example: NHS Scotland immunisation and vaccination programmes are decided nationally, with national Impact Assessments. In NHS Lothian, the Public Health Immunisation Team carry out Impact Assessments to develop implementation plans. National and previous local impact assessments, as well as up to date local population and equality monitoring data, help identify ways to help increase uptake in particular groups by understanding and removing barriers. Page 137 of 348
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Equality. Fairer Scotland. Children’s Rights Impact Assessment Guidance 6 Assessing impact at a strategic level Strategies and strategic plans set our direction and assessing their potential impact allows us to identify relevant equality and children’s rights priorities or outcomes. Your proposed strategy should be as specific as possible about the equality groups and children’s rights affected. In most cases, you will be guided about relevant equality and children’s strategic priorities or outcomes by national policies and outcomes, and evidence of significant inequalities. However, your impact assessment will allow you to identify gaps, opportunities or different outcomes that you want to achieve. Impact Assessments of proposed strategies or strategic plans should consider high level strategic frameworks including: • The Scottish Government’s National Outcomes in the National Performance Framework • NHS Lothian’s Strategic Development Framework • NHS Lothian’s Equality and Human Rights Strategy You do not have to identify ‘how’ to reduce inequalities – that will come during the Impact Assessment of the strategy’s programmes and projects. Example: A workforce development strategy aims to create jobs and training opportunities. The evidence collected as part of the impact assessment identifies that the Scottish Government is committed to halving the disability employment gap and ensuring minority ethnic people have equal and fair access to employment. Locally, disabled people and people from certain BME communities have particularly high unemployment rates and are under-represented in the organisations workforce. The organisation also has a policy of improving employment opportunities for care experience people, to help meet its Corporate Parenting duties. The results of the Impact Assessment are used to include a commitment to improving employment outcomes for disabled people, people from BME communities and people with care experience in the new strategy. Page 138 of 348
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Equality. Fairer Scotland. Children’s Rights Impact Assessment Guidance 7 1 Planning the process Some work will be broad and affect everyone working for us or using our services, but some may only affect specific groups of people. You will need to identify who will be affected at the start. Identify who is affected by your proposed work Your Impact Assessment should only collect evidence about the groups of people who will be affected and assess the potential impact on them. Example: A vaccination helpline will only affect specific groups of people who are eligible for the vaccination. Who should be involved in the Assessment? The Project or Service Lead is responsible for ensuring an Impact Assessment is completed. You will need a range of relevant perspectives to consider the impact of your work and so you should include a range of people in your assessment including people with: • Responsibility for developing the work. • Responsibility for implementing the work. • Operational or front-line perspective. • Relevant protected characteristics, with experience of living in poverty, children and young people or people from organisations that represent them. There are different parts of the process and ways to involve people. You can approach people individually or in groups as part of your evidence gathering. It’s normally helpful to do the assessment with others. You can do this in the project team or arrange a meeting with a broader group to help you. However, the approach you take will depend on the type and scale of your proposal. The results of your Impact Assessment must be shared with the person or group making the final decision about the proposal. The courts have confirmed that the legal duty to consider equality is on decision makers, and what matters is what they know and take into account when making decisions. Page 139 of 348
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Equality. Fairer Scotland. Children’s Rights Impact Assessment Guidance 8 2 Collecting the evidence Collecting and using evidence allows us to understand the reality of people’s lives. You will need evidence about the needs and experiences of the people affected by your proposal including: • Who does and doesn’t access our services and our staff • Health and employment inequalities experienced by groups of people. • Barriers to participation in, or access to, relevant activities and services • How to meet different needs. Evidence can come from: • Internal equality monitoring data, consultations, or public engagement. • External research reports. • National and local population data. If there are gaps in your evidence, you should proactively involve the relevant groups and communities. Where it’s not possible to gather new information in time to inform your assessment you should include actions to collect this as part of monitoring the impact of your proposal once implemented. You need to present your evidence in a way that helps people understand it. This is of particular importance when gathering evidence for a strategy – as it will be critical for the programmes and projects that emerge from the strategy. Page 140 of 348
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Equality. Fairer Scotland. Children’s Rights Impact Assessment Guidance 9 Useful places to collect evidence The Equality and Human Rights Team can provide contact details for equality and community organisations, and advice about how to support the participation of different groups. • NHS Lothian Equality and Human Rights Evidence Paper and Impact Assessment results • Lothian Analytical Services • NHS Lothian annual equality and diversity monitoring report • NHS Lothian Director of Public Health Annual Report • NHS Lothian Minority Ethnic Health Information Services (MEHIS) • NHS Lothian LGBT+ Health Needs Assessment • NHS Lothian Equality staff networks • Scottish Government Long-term monitoring of health inequalities collection of annual reports • Patient or stakeholder groups • Trade unions • Staff responsible for delivering similar policies/past Integrated Impact Assessments • Public Health Scotland Website • NHS Lothian Analytical Services • Scottish Government Equality Evidence Finder • Scottish Parliament Research Briefings • Scottish Government – Supporting disabled children, young people and their families: guidance • Equality and Human Rights Commission Is Scotland Fairer • Scottish Neighbourhood Statistics • Scottish Household Survey • Scottish Attitudes Survey • Scotland’s Census • Edinburgh Equality and Rights Network (may be able to commission a focus group) • Scottish Index of Multiple Deprivation • Scottish Government official statistics • Children and Young People Data on Tableau Public • Children’s Health in Care in Scotland (CHiCS) Main Findings from population-wide research (2022) • Who Cares? Scotland • Children’s Parliament • Together: Scottish Alliance for Children’s Rights • Children & Young People’s Commissioner Scotland • Celcis: Statistics about children and young people in and leaving care • University of Edinburgh Centre for Homelessness and Inclusion Health • UN Convention on the Rights of the Child - UNICEF UK • Integration Joint Board Strategic Assessments Page 141 of 348
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Equality. Fairer Scotland. Children’s Rights Impact Assessment Guidance 10 3 Assessing the impact After collecting your evidence, you must use it to assess the potential impact your work could have on equality, socio economic inequality and children’s rights. This means for each relevant group you must consider if your work could: • Result in unlawful discrimination or disadvantage. • Help to advance equality of opportunity and foster good relations. • Reduce health and employment inequalities caused by socio economic disadvantage. You also need to consider if your work could restrict or progress relevant UN Convention on the Rights of the Child (UNCRC) rights. It is helpful to involve others to assess impacts of your proposal. You should share evidence you have collected with them and check for any gaps. You can assess the potential impact in a group, in writing or in a meeting. The approach you take will depend on your proposal, what you think will help you. Page 142 of 348
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Equality. Fairer Scotland. Children’s Rights Impact Assessment Guidance 11 Negative and positive impact The work we do can have potentially positive and negative impacts on our overall aim of improving the health and wellbeing of everyone in Lothian. A Negative Impact stops us from improving the health and wellbeing of everyone in Lothian. This could be through: • Unlawful discrimination • Widening inequalities • Contributing to worse relations or increased intolerance between people • Restricting children’s rights. If you identify any potential unlawful discrimination or disadvantage, you must identify how to prevent, or reduce this. Example: If we don’t provide support or alternative arrangements for an online vaccination booking system, we may unlawfully discriminate against disabled people by failing to meet the reasonable adjustment duty. We may also increase health inequalities experienced by older people, gypsy traveller communities and people living in poverty. A Positive Impact supports us to improve the health and wellbeing of everyone in Lothian. This could be through: • Removing disadvantage • Meeting different needs • Increasing participation • Reducing inequalities and prejudice • Progressing children’s rights. If you identify the potential to make a positive impact, you must include actions to achieve this. Example A targeted women’s health improvement campaign may reduce inequalities because women in Lothian lose more years of their life to ill health and some face additional barriers to accessing health services. Parts of the campaign are designed to reach women with the worst health outcomes – women with learning disabilities, living in Gypsy Traveller communities, of African and Caribbean descent, and those living in the most deprived areas. Page 143 of 348
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Equality. Fairer Scotland. Children’s Rights Impact Assessment Guidance 12 Impact on equality Protected characteristics Some groups of people share certain characteristics, and experience discrimination and inequality related to these characteristics. The Equality Act 2010 provides protection from discrimination and harassment related to these characteristics. This ensures that everyone, at work or using a service, has the right to be treated fairly. These characteristics are known as protected characteristics and are: • Age • Disability • Gender reassignment • Marriage and civil partnership • Pregnancy and maternity • Race • Religion and Belief • Sexual Orientation • Sex Public Sector Equality Duty The Act also aims to advance equality of opportunity for everyone and includes the Public Sector Equality Duty, which requires us, to have ‘due regard’ to the need to: • Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by or under this Act. • Advance equality of opportunity between people who share a relevant protected characteristic and those who do not share it. • Foster good relations between people who share a relevant protected characteristic and those who do not. Page 144 of 348
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Equality. Fairer Scotland. Children’s Rights Impact Assessment Guidance 13 Eliminating unlawful discrimination Direct discrimination – we must not treat someone less favourably because of a protected characteristic. Example: A man is not offered a job in an all-female team, despite meeting all the recruitment criteria, because the manager is concerned that he would feel unhappy and uncomfortable in an all-female environment. Indirect discrimination – we must not put someone with a protected characteristic at a disadvantage unless it is a proportionate way to achieve a legitimate aim. Example: A health board policy on access to assisted conception includes a requirement for people to have had heterosexual sex for two years before being considered for fertility treatment. This indirectly discriminates against people in relation to sexual orientation because this rule puts lesbians at a particular disadvantage. Although this criteria could be about achieving a legitimate aim there may be less discriminatory ways to achieve the same aim. Discrimination arising from disability – we must not treat a disabled person unfavourably because of something connected with their disability if this cannot be objectively justified. Example: A manager issues a written warning [this is the unfavourable treatment] to a disabled member of staff because they have been absent from work a lot. The absence is because they needed to attend hospital appointments related to their disability. Instead, the manager should have followed the capability performance procedure before deciding if action was needed. A failure to make a reasonable adjustment – we must make adjustments to remove, reduce or prevent barriers faced by disabled people, where it is reasonable to do so. It will always be reasonable to provide information in an accessible format if not doing so would put someone at a substantial disadvantage. Examples of reasonable adjustments: - changing physical features such as steps or seating - changing the way we do things - providing aids such as voice recognition software, a hearing loop, assistance dog, BSL interpreter You can find more about accessible information on the Scottish Government website - What we mean when we talk about accessibility - Accessibility in government (blog.gov.uk) and Accessible communication formats - GOV.UK (www.gov.uk) Page 145 of 348
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Equality. Fairer Scotland. Children’s Rights Impact Assessment Guidance 14 Eliminating harassment and victimisation Harassment – we must not allow unwanted behaviour related to a protected characteristic that could violate someone’s dignity or create an intimidating, degrading, humiliating or offensive environment for them. Examples of unwanted behaviour: - spoken or written abuse – this could be ‘banter’, emails, online comments or graffiti - physical gestures/facial expressions. Victimisation – we must not allow someone to treat another person badly because they have done a ‘protected act’ in good faith - for example they have made, or supported someone else who is making a complaint of discrimination or harassment. Example: Someone made a complaint that their GP's receptionist discriminated against them because of their mental health condition. As a result, the GP practice manager tells them to leave and register with another practice. Taken from www.mind.org.uk Advancing equality of opportunity Advancing equality of opportunity is about: • Removing or minimising disadvantage suffered by people due to their protected characteristics. • Taking steps to meet the needs of people with certain protected characteristics where these are different from the needs of other people. • Encouraging people to participate in public life or in other activities where the participation of people with certain protected characteristics is disproportionately low. Fostering good relations Fostering good relations is when we tackle prejudice and promote understanding between people from different groups. Page 146 of 348
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Equality. Fairer Scotland. Children’s Rights Impact Assessment Guidance 15 Positive Action We can take positive action to improve equality for people who share a protected characteristic if the statutory conditions for this are met. We must reasonably think that people who share a protected characteristic: a) experience a disadvantage connected to that characteristic, b) have needs that are different from the needs of people who do not share that characteristic or c) have disproportionately low participation in an activity compared to others who do not share that protected characteristic. We can take any action which is proportionate to meet the aims set out in the Equality Act 2010 to: a) Remedy the disadvantage. b) Meet the needs. c) Enable or encourage participation. Example – LAWFUL because it is non-discriminatory We are allowed to place a job advertisement in a magazine with a largely lesbian and gay readership as well as placing it on a national recruitment website. Example – LAWFUL positive action because it meets the conditions in the Equality Act 2010 We may be allowed to reserve places on a training course for young people if we can show they have disproportionately low participation in this area, and it will help to enable and encourage young people to participate. Example – UNLAWFUL action because it is direct discrimination We are not allowed to limit interviews for a job to women only, unless we can show there is an occupational requirement that only women can do this job (e.g. support workers in an organisation providing support for women who experiencing domestic abuse). Page 147 of 348
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Equality. Fairer Scotland. Children’s Rights Impact Assessment Guidance 16 Impact on inequalities caused by socio-economic disadvantage The Fairer Scotland Duty places a legal responsibility on us to have due regard to how we can reduce inequalities of outcome caused by socio-economic disadvantage. The Fairer Scotland Duty Guidance recommends including this within the equality impact assessment process. In broad terms, ‘socio-economic disadvantage’ means living on a low income compared to others in Scotland, with little or no accumulated wealth, leading to greater material deprivation, restricting the ability to access basic goods and services. Socio-economic disadvantage can be experienced in terms of the places where people live and/ or the protected characteristics they share. People experiencing socio-economic disadvantage means people: • With low income – cannot afford to maintain regular payments such as bills, food, clothing. • With low/no wealth – enough money to meet basic living costs and pay bills but have no savings to deal with unexpected spends and no provision for the future. • Living in material deprivation – being unable to access basic goods and services. • Living in deprived areas – where you live, where you work, visit or spend a continuous amount of time can all have an impact. • From particular socio-economic backgrounds – disadvantage that can arise from parents’ education, employment and income or social class. Example When NHS 24 needed to relocate they included tackling inequality caused by socio economic disadvantage into their relocation case criteria as a ‘non-financial benefits’ criteria. This has encouraged NHS 24 staff to consider how relocation plans could create employment opportunities in diverse and more deprived communities and how businesses in the local community could be supported. Taken from www.gov.scot Page 148 of 348
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Equality. Fairer Scotland. Children’s Rights Impact Assessment Guidance 17 Impact on children’s rights The Children and Young People (Scotland) Act 2014 includes duties on us to uphold and progress the UN Convention of the Rights of the Child (UNCRC) for everyone under 18. Legislation to incorporate UNCRC into Scots law is expected to come into force in 2024. It is expected that this will require us to take proactive steps to ensure we are protecting children’s rights when we are making decisions and delivering services, and to report on the progress we’re making to do this. We have duties as Corporate Parents for all Care Experienced children and young people under 26. It is the duty of every Corporate Parent, so far as is consistent with their functions to do the following for a child or young person: a) Be alert to matters which, or which might, adversely affect their wellbeing. b) Assess theirneeds. c) Promote their interests. d) Try to provide opportunities to participate in activities to promote their wellbeing. e) Take such action as considered appropriate to help them access opportunities and make use of our services and access support we provide. Page 149 of 348
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Equality. Fairer Scotland. Children’s Rights Impact Assessment Guidance 18 Discussion points This information may help you structure your evidence gathering and when you are assessing the potential impact of your proposal. It is not exhaustive and just to be used as a starting point. Protected characteristics Age • Adverse Childhood Experiences including abuse, neglect or poverty are a determinant for future health outcomes. • Care Experienced children and young people are at greater risk of being homeless and have poorer health outcomes with higher rates of prescriptions for depression, greater psychiatric outpatient clinic attendance, and acute inpatient admissions. • Babies and infants are less able to have their voices and opinions heard/listened to. • Women outnumber men in older age groups. • Older people are more likely to face barriers accessing online services. • Approximately 9% of Scotland’s population over the age of 65 have a diagnosis of dementia. • 43% of carers are between 45-64. Many children and young people are carers. Disability • Around 30% of adults and 10% of children are disabled. • Some people may have needs such as mobility, speech, hearing, sight, memory, neurodiversity. They may require wheelchair access, induction loops, large print text, switches at accessible heights, British Sign Language (BSL) interpreters, speech to text provision, BT relay service, BSL Video Relay Service, double appointments. • Some people may have needs caused by their experiences of trauma, abuse, pain and anxiety. This may affect their ability to access services and build trusting relationships. They may require adjustments to the way services are provided, to allow them to ask for, and receive help. • Some people find it difficult to access services via public transport or walking. • People whose first language is British Sign Language (BSL) cannot be assumed to read English well as it is not their first language. • Many disabled people experience harassment and abuse related to their disability. • Disabled people are more likely to live in poverty and have higher daily living costs. • Disabled children are more likely to experience abuse or neglect. • On average the life expectancy of people with a learning disability is shorter than the general population. Page 150 of 348
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Equality. Fairer Scotland. Children’s Rights Impact Assessment Guidance 19 Gender reassignment • Trans people often report poor experience when using services primarily related to attitudes of and assumptions made by staff. • Trans people may have needs in relation to modesty (e.g. privacy in changing areas, provision of single sex accommodation, appropriate uniforms/dress code). • There is a risk of health professionals misdiagnosing people through assumptions about their gender identity, inadequate knowledge about some identities and concerns about confidentiality. Marriage and civil partnership • The protection from discrimination on the basis of this characteristic applies only in employment situations. There is no legal requirement to consider how to advance equality of opportunity or foster good relations in relation to this. Pregnancy and maternity • Pregnancy and maternity discrimination is when there is unfavourable treatment during the protected period, which is 26 weeks beginning with the date gave birth. • Pregnancy and maternity leave can have a negative impact on employment opportunities and income. • Pregnancy is one of the key triggers that increase the risk of women living in poverty, particular, where they are lone parents. There are services that support women during pregnancy and maternity period to make sure they get the pay and benefits they are entitled to. • Pregnant women and new mothers in the asylum system are particularly vulnerable to poverty. • The UK has the second highest rate of teenage pregnancies out of the 21 most developed countries. Teenage pregnancy is linked to deprivation, with rates of teenage pregnancy in deprived areas of Scotland more than treble those of the least deprived. Teenage pregnancy is often a cause and a consequence of increased social exclusion and reduced access to state services such as education, training and benefits. • Having diabetes put mothers and their babies at more risk of serious health complications during pregnancy and childbirth. Planning ahead and support from health professionals can reduce the risks involved. Page 151 of 348
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Equality. Fairer Scotland. Children’s Rights Impact Assessment Guidance 20 Race/ethnicity • Discrimination and other social determinants of health contribute to racialised health inequalities. • Some people may require interpreters and translated materials. People may not be literate in their own language and have an oral tradition for communication. NHS Lothians has a translation service. It is against NHS Lothian policy for friends or relatives to act as interpreters during treatment or appointments. • Some self-management information may show examples of disease on pale skin which might make it harder to diagnose on darker skin. • Some people may have cultural needs in relation to diet, modesty (e.g., privacy in changing areas, provision of single gender accommodation, appropriate uniforms/dress code), bathing and personal care, organ/tissue donation, blood sharing and certain drugs/treatments. • Some diseases such as heart disease, diabetes, HIV are higher in some communities. • Many refugees and asylum seekers have physical and mental health problems associated with the reason they have had to seek asylum. • Gypsy Travellers and Roma people have the poorest health outcomes than any other social or ethnic group. The life expectancy is 50 years for both men and women. Religion or belief • Health beliefs, values and needs vary between cultures and religions and between individuals with cultural and religious groups. • Culturally competent care can improve healthcare outcomes. • Be respectful of employee’s religion or belief. This includes being sensitive to employee’s needs in terms of uniforms, dietary requirements, providing a room for prayer and time off for religious observance. • Our own beliefs and biases can influence how we interpret other people’s needs. Sex • Men have lower life expectancy, but women are more likely to suffer ill health, suggesting that women spend more years in poor health. • Women are more at risk of gender-based violence, young men are more likely to be involved in violence or accidents. • Sometimes separate or services for women and men are more effective at meeting needs. Providing single-sex services might be needed if someone of the opposite sex might reasonably object to the presence of someone of the opposite sex. • Carers are disproportionately female - 61% are women and 39% are men. • The average life expectancy for a homeless person is 47 for men and 43 for women. Sexual orientation • LGB people are at a higher risk of mental health problems than heterosexual people, including self-harm, suicidal thoughts, increased alcohol, drug and tobacco use. • Some LGB people report experiences of homophobia when using health services. • Gay and bisexual men are less likely to be registered with a GP. • Gay men represent the group most at risk from HIV transmission. Page 152 of 348
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Equality. Fairer Scotland. Children’s Rights Impact Assessment Guidance 21 Socio-economic disadvantage • Around 11% of Lothian’s population live in areas categorised as among the 20% most deprived in Scotland. The greatest number are in Edinburgh. West Lothian has the highest share of its population living in the most deprived communities (14%). • Living in deprived areas is sometimes connected to lower healthy life expectancy than affluent areas, higher mortality and morbidity, and poorer mental health. • The inequalities that people can face because of socio-economic disadvantage include poorer skills and attainment, lower healthy life expectancy, lower quality, less secure and lower paid work, greater chance of being a victim of crime and or less chance of being treated with dignity and respect. • People describing themselves as African, Caribbean or Black are much more likely to be living in the most deprived areas than other ethnic groups. • After years of decline, homelessness is on the rise again. • Caring responsibilities may limit participation in employment, education and other aspects of life. This may impact on social status, income, mental and physical health. • In 2020-21, 14% of young carers lived in the 10% most deprived areas. Children’s Rights Everyone under the age of 18 has human rights set out in the United Nations Convention on the Rights of the Child UNCRC. • Article 3 – the best interests of the child shall be a primary consideration. • Article 4 - measures to implement UNCRC rights. • Article 5 – the responsibilities, rights and duties of parents or where applicable others, shall be respected in a manner consistent with the evolving capacities of the child, with the appropriate direction and guidance by the child. • Article 6 – to live and the survival and development of the child will be ensured to the maximum extent possible. • Article 7 – to a name, nationality, and as far as possible to know and be cared for by their parents. • Article 8 – to preserve their identity. • Article 9 – not to be separated from their parents against their will, except when competent authorities subject to judicial review determine, in accordance with the law and procedures, that separation is necessary for the best interests of the child. • Article 10 – immigration decisions about family reunification to be dealt with in a positive, humane and expeditious manner. • Article 11 – combat the illicit transfer and non-return of children abroad. • Article 12 – the child who is capable of forming their own views shall have the right to express those views freely in all matters affecting the child. • Article 13 – freedom of expression. • Article 14 – freedom of thought, conscience, and religion. • Article 15 – freedom of association and freedom of peaceful assembly. • Article 16 – no child shall be subject to arbitrary or unlawful interference with his or her privacy, family, home or correspondence. • Article 17 – access to mass media information from a diverse range of sources Page 153 of 348
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Equality. Fairer Scotland. Children’s Rights Impact Assessment Guidance 22 • Article 18 – both parents have common responsibilities for the upbringing and development of the child. • Article 19 – protection from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation. • Article 20 – a child temporarily or permanently deprived of their family environment, or because it is in their own best interests not to be allowed to remain in that environment, shall be entitled to special protection and assistance. • Article 21 – system of adoption ensures best interests of child is paramount • Article 22 – take appropriate measures to ensure that a child who is seeking refugee status or who is considered a refugee…receive appropriate protection and humanitarian assistance in the enjoyment of applicable rights. • Article 23 – a mentally or physically disabled child should enjoy a full and decent life, in conditions that ensure dignity, promote self-reliance, and facilitate the child’s active participation in the community. • Article 24 – enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. To strive to ensure that no child is deprived of their right to access such health care services. • Article 25 – a child placed by competent authorities for the purposes of care, protection or treatment of their physical or mental health has right to a periodic review of treatment. • Article 26 – to social security • Article 27 – to standard of living adequate for their development • Article 28 – right to education • Article 29 – direction of education • Article 30 – a child belonging to an ethnic, religious or linguistic minority group will not be denied the right… to enjoy their own culture, to profess or practice their own religion or to use their own language. • Article 31 – to rest and leisure, to engage in play and recreational activities appropriate to their age and to participate freely in cultural life and the arts. • Article 32 – protection from economic exploitation • Article 33 – protection from illicit use of narcotic drugs and psychotropic substances • Article 34 – protection from all forms of sexual exploitation and sexual abuse • Article 35 – prevention of adduction, sale or trafficking • Article 36 – protection against all forms of exploitation prejudicial to any aspect of their welfare. • Article 37 – no child shall be subjected to torture or other cruel, inhuman or degrading treatment or punishment. No child shall be deprived of their liberty unlawfully or arbitrarily. • Article 38 – respect for rules of international humanitarian law in armed conflict. • Article 39 – to take all appropriate measures to promote physical and psychological recovery and social reintegration of a child victim of any form of neglect, exploitation, or abuse, torture or any other form of cruel, inhuman or degrading treatment or punishment, or armed conflicts. Page 154 of 348
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Equality. Fairer Scotland. Children’s Rights Impact Assessment Guidance 23 4 Sharing with decision makers Decision makers have a legal duty to consider equality. They need sufficient knowledge to allow them to make a decision. These principles can also be applied to how we meet the Fairer Scotland Duty and uphold children’s rights. Decision makers must: • Be told if the duty to consider equality applies to their decision. They will need to keep a record either way if they: o Do have a duty to consider equality before they make a decision you need to give them the results of your Impact Assessment. o Do not have a duty to consider equality before they make a decision you need to submit a statement to explain this. • Consider equality at the time a decision is taken. They must do this ‘in substance, with rigour and an open mind, not a tick box’. • Assess the risk and extent of any potential discrimination and disadvantage and the ways to eliminate or minimise it before the proposal is agreed. To do this they must ensure the Impact Assessment is of a sufficient standard – that it includes a clear outline of the proposal, the groups affected, evidence and any potential impacts. If they don’t have enough information to assess this risk, they must ask for additional information until they can make an informed decision. Page 155 of 348
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Equality. Fairer Scotland. Children’s Rights Impact Assessment Guidance 24 5 Publishing your results As soon as possible after your policy is implemented, you are required, by law, to publish the results of your Impact Assessment. Send the report to impactassessments@nhslothian.scot.nhs.uk 6 Monitoring the impact An Impact Assessment is an ongoing process. You should identify the actual impact once your proposal is implemented. You should include equality indicators in your performance reports. These should show the effect your policy is having on reducing inequalities for example if you are seeing increased participation rates, better outcomes, fewer complaints, or more positive feedback from people from the groups where inequalities were identified. Equality monitoring data will help you to understand the difference you are making. So can questionnaires or surveys. The purpose of collecting this information is to review whether your work is having the desired effect and, if not, consider how to change it or, if necessary, stop it and try something else. To be effective, monitoring requires baseline information from the beginning. This means identifying indicators that represent the issue and/or UNCRC right you are trying to address. You may want to align to NHS Lothian or national indicators, Scottish Government’s National Performance Indicators, Local Outcome Improvement Plans or Community Planning Partnership indicators. If you cannot identify an appropriate existing indicator, you should consider whether you can develop a bespoke measurement. Your indicators should be able to reflect the effect on people’s lives, not just output measures such as actions taken. Page 156 of 348
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Midlothian Integration Joint Board Thursday 21st December 2023, 14:00-16:00 IJB Performance Report Executive summary The purpose of this report is to update the IJB on progress towards the IJB performance goals set for the financial year 2022/23. Due to the processes required to validate these data, the full reporting year is almost complete for all indicators (indicators at 3.11 and 3.12 are outstanding). A report describing progress against each improvement goal is attached in Appendix 1. There is an inbuilt reporting delay (noted above). More recent management data are available for a number of the improvement goals but as they have not been validated, they cannot be published. In order to support the Board’s understanding of the current position regarding progress towards the improvement goals, a brief summary is provided. Following the Midlothian IJB meeting on 13th April 2023, the Performance, Assurance, and Governance Group (PAGG) was commissioned to consider a local improvement goal(s) for the IJB. The group met on 4th May and collaboratively produced one improvement goal with 8 locally relevant process measures. The initial data collection test has been completed and a process for sharing with MIJB requires to be agreed and established. Following the invitation from Scottish Government to participate in the consultation regarding the revised guidance for publication of Annual Performance Reports, the Performance, Assurance, and Governance Group (PAGG) dedicated their September meeting to discuss and agree feedback. The November meeting of PAGG provided an opportunity to update on the project to improve the visualisation of management data for ED attendance, admissions and delayed discharges. The increase in functionality means we can now better understand the profile of need for unscheduled care. Members are asked to: • Note the performance against the IJB Improvement Goals for 2023/24 (Appendix 1). Item number: 5.7 Page 157 of 348
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Midlothian Integration Joint Board • Confirm the process for examination / publication of Local Improvement Goal process measure data. Page 158 of 348
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Midlothian Integration Joint Board Midlothian Integration Joint Board IJB Performance Report 1 Purpose 1.1 The purpose of this report is to update the IJB on progress towards the IJB performance goals set for the financial year 2022/23. Due to the processes required to validate these data, the full reporting year is almost complete for all indicators. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the performance against the IJB Improvement Goals for 2023/24 (Appendix 1). • Confirm the process for examination / publication of Local Improvement Goal process measure data. 3 Background and main report 3.1 The IJB has previously identified improvement goals to monitor progress on reducing unscheduled hospital activity and use of institutional care. They are based on goals recommended by the Scottish Government Ministerial Strategic Group for Health and Community Care). 3.2 At the IJB meeting in June 2022 the Performance Assurance & Governance Group recommended that the improvement goals for 2022/23 were set to prioritise an increase in system stability, focussing on workforce recovery and wellbeing. 3.3 An updated report describing progress against each improvement goal is attached in Appendix 1. This report is produced by the Local Intelligence Support Team (LIST) on behalf of the Midlothian HSCP. Members are asked to note the information in Appendix 1, specifically regarding data completeness. Due to the processes required to validate these data for publication, there is an inbuilt reporting delay, and this information is not taken from a “live” system. This means that we are not yet able to calculate the full year performance for some measures. 3.4 Members are asked to note that Public Health Scotland (PHS) has moved to a schedule of quarterly, rather than monthly, updates. 3.5 More recent management data are available for a number of the improvement goals but as they have not been validated, they cannot be published. In order to support the Board’s understanding of the current position regarding progress towards the improvement goals, a brief summary is provided below. 3.6 A&E Attendances 2022/23 Target Rate per 100,000 people 2,629 / month Page 159 of 348
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Midlothian Integration Joint Board 2023/24 Running Average 2,787 / month The validated data are available up to June 2023. Based on this information, the target is not currently being met. The most recent non-validated management information data indicate an improved position, currently meeting the target. 3.7 Emergency Admissions 2022/23 Target Rate per 100,000 767 / month 2021/22 Rate 800 / month The validated data are only available up to March 2022. Based on this information, the target is not currently being met. The most recent non-validated management information data indicate that system activity levels continue to present a significant challenge to achieving the target set. 3.8 Unplanned Bed Days (Acute) 2022/23 Target Rate per 100,000 5,074 / month 2021/22 Rate 4,783 / month The validated data are only available up to March 2022. Based on this information, the target is currently being met. The most recent non-validated management information data indicate a further improvement, currently meeting the target. 3.9 Delayed Discharge Occupied Bed Days 2022/23 Target Rate per 100,000 820 / month 2023/24 Running Average 662 / month The validated data are only available up to June 2023. Based on this information, the target is currently being met. 3.10 End of Life – Percentage of Last Six Months Spent in Large Hospitals 2022/23 Target Rate <8.7% 2020/21 Rate 7.9% (provisional data) The validated data are only available on a provisional basis for 2020/21. Based on this information, the target is currently being met. It is not possible to refer to management information as these data are not held locally. 3.11 Balance of Care 2022/23 Target Rate >96.4% 2021/22 Rate 96.9% (provisional data) The validated data are only available on a provisional basis for 2021/22. Based on this information, the target is currently being met. It is not possible to refer to management information as these data are not held locally. 3.12 IJB Local Improvement Goal Following the Midlothian IJB meeting on 13th April 2023, the Performance, Assurance, and Governance Group (PAGG) was commissioned to consider a local improvement goal(s) for the IJB. The group met and collaboratively produced one improvement goal with a number of proposed locally relevant process measures. The Goal, Outcome and Balancing Measures are detailed below: Goal: The balance of care from hospital to community-based care in Midlothian will have shifted by x% by March 2025 (percentage to be defined). Outcome Measure: % of shift from hospital to community-based care Page 160 of 348
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Midlothian Integration Joint Board Balancing Measures: (quarterly from PHS) Our recommendation is to use the MSG indicators here as we already report on these. 3.13 The initial data collection test has been completed and a process for publication requires to be agreed and established. As the measures relate to management information that cannot be validated for the public domain, it is suggested that the data are examined in detail by the Performance Assurance and Governance Group each month, and then submitted to MIJB as a private paper. 3.14 Following the invitation from Scottish Government to participate in the consultation regarding the revised guidance for publication of Annual Performance Reports, the Performance, Assurance, and Governance Group (PAGG) dedicated a meeting to discuss and agree feedback. This took place on Thursday 14th September 2023 and comments were passed to the Midlothian HSCP Integration Manager. 3.14 The Midlothian HSCP Performance Manager and the Principal Information Analyst (PHS Local Intelligence Support Team) contributed to a 6-month project using NHS analytical resource secured by the Depute Chief Exec’s Office to improve an existing Tableau dashboard (which had originally been built by colleagues in LIST). 3.15 The dashboard visualised weekly data for ED attendance, admissions and delayed discharges, which could be filtered by HSCP, by locality, by GP practice, by age and sex. Based on the input from the HSCP Performance Leads across Lothian, a number of improvements were made including additional filters to show: • weekly / monthly / quarterly data • SIMD • Protected characteristics (starting with ethnicity) with a caveat regarding current data quality issues. 3.16 This increase in functionality means we can now better understand the profile of need for unscheduled care and will support us in our work to better understand and ultimately reduce, health inequalities (in support of Direction 5.1). 4 Policy Implications 4.1 There are no policy implications arising from this report. 5 Directions 5.1 This report does not directly impact upon service ability to deliver existing Directions. It is acknowledged that there will be a requirement for ongoing review and revision to the Performance Report, in alignment with any revisions to existing Directions / issue of new Directions at any stage in the reporting period. 6 Equalities Implications 6.1 There are no equality implications from focussing on these goals but there may be implications in the actions that result from work to achieve them. Page 161 of 348
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Midlothian Integration Joint Board The focus of most of the goals is on reducing hospital activity and hospitals are not used equally by the population. There are groups of people that make more use of hospitals than others – for example older people, people living in areas of deprivation or people who live alone. 7 Resource Implications 7.1 There will be resource implications resulting from further action to achieve these improvement goals. 8 Risk 8.1 The risk of not finding solutions to address complex performance measurement challenges is that we are underinformed in relation to increases in complexity, acuity and the resulting additional pressures these create for our workforce; and what this may mean for wellbeing, retention and recruitment. 9 Involving people 9.1 The Performance Assurance & Governance Group (PAGG) meet monthly to review and discuss these and other measures as part of wider data assurance. Membership of the group will be expanded to ensure increased representation of elected officials, the third sector and public health. 10 Background Papers 10.1 No background papers. AUTHOR’S NAME Elouise Johnstone DESIGNATION Strategic Programme Manager for Performance CONTACT INFO elouise.johnstone@nhslothian.scot.nhs.uk DATE 4th December 2023 Appendices: Appendix One: Local Intelligence Support Team (LIST) Report describing progress against the IJB improvement goals 2022/23. Page 162 of 348
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Midlothian HSCP MSG Indicators Performance from April 2019 to June 2023, with 2020/21 MSG targets and trends Local Intelligence Support Team (LIST), Nov 2023 Page 163 of 348
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Contents 1. Methodology 2. Data completeness 3. 2020/21 MSG targets and actuals 4. A&E attendances 5. Emergency admissions 6. Unplanned bed days (Acute) 7. Delayed discharges occupied bed days Page 164 of 348
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2020/21 MSG Targets - Methodology • The MSG Objectives Performa was submitted in February 2020 which specified the 2020/21 targets and an action plan on how those targets were to be achieved • 2017/18 MSG data was used as the baseline to calculate the 2020/21 targets Page 165 of 348
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Data completeness Source: MSG data release Sep-23, PHS Page 166 of 348
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2020/21 targets and actuals Source: MSG objectives 2020-21 template - Midlothian IJB; MSG data release Sep-23, PHS • Indicators 3b and 6 are still provisional. Page 167 of 348
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Data Sources 2020/21 MSG Targets • Source: MSG data release v1.64, Sep-23; Public Health Scotland • These are official monthly figures released by PHS and will be nationally published (some data is provisional and not yet published) • Next data release: Dec-23 Page 168 of 348
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A&E Attendances Source: MSG data release Sep-23; data published up to Jun-23 1,200 1,400 1,600 1,800 2,000 2,200 2,400 2,600 2,800 3,000 3,200 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar No. of A&E attendances per 100,000 2019/20 2020/21 2021/22 2022/23 2023/24 2020/21 Target Page 169 of 348
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Emergency Admissions Source: MSG data release Sep-23; data published up to Mar-22 0 200 400 600 800 1,000 1,200 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Number of emergency admissions per 100,000 2019/20 2020/21 2021/22 2020/21 TargetPage 170 of 348
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Unplanned Bed Days - Acute Source: MSG data release Sep-23; data published up to Mar-22 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Acute unscheduled bed days per 100,000 2019/20 2020/21 2021/22 2020/21 TargetPage 171 of 348
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Delayed Discharges Occupied Bed Days Source: MSG data release Sep-23; data published up to Jun-23 0 200 400 600 800 1,000 1,200 1,400 1,600 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Delayed discharge bed days per 100,000, all reasons (18+) 2019/20 2020/21 2021/22 2022/23 2023/24 2020/21 Target Page 172 of 348
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End of Life - Percentage of Last Six Months Spent in Large Hospitals Source: MSG data release Sep-23; data published up to 2020/21 Target = decrease Annual 2020/21 Target <8.7% 2019/20 9.1% 2020/21 7.5% 2021/22 (provisional) 7.9% Page 173 of 348
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Midlothian Integration Joint Board Thursday, 21st December 2023, 14:00-16:00 Integrated Assurance Report Executive summary This report is presented to provide Midlothian Integration Joint Board (IJB) with assurance around the processes in place to deliver clinical and care governance and risk and resilience management by the Midlothian Health and Social Care Partnership. The structure for oversight of safe, effective, and person-centred care and professional governance consists of the Clinical Care and Governance Group and Quality Management Groups (QMGs). In addition, a number of specialist subgroups ensure focus on identified risks and most common harms. A culture of shared learning and improvement is promoted. This report further updates the Board on progress around professional Social Work and Social Care governance. The Governance and Assurance Framework (GAF) has been in use for 2 reporting cycles and ongoing work to refine this approach is planned. This prompted a review of the 6 Governance Groups that report to the Senior Management Team: Clinical Care and Governance, Integrated Workforce Governance Board, Finance and Performance, Business Governance, Digital Programme Board, and the Partnership Forum. Work continues to ensure that areas highlighted as medium or low assurance by services in the Governance and Assurance Framework are additionally reviewed by the relevant Governance Group (Appendix 1). Group Service, Service, and Team Plans are in place across the HSCP, and proposals are in place to take progress reports and develop plans for the next financial year, based on any risks identified. This aims to provide a consistent and complete picture of the assurance being reported and will support the ambition to implement a total Quality Management System (QMS) linking clinical and care governance with the management of performance and resources. A joint Care Inspectorate and Healthcare Improvement Scotland adult inspection has been recently completed with a focus on services for people with a Physical Disability. The report of this inspection was published on 28th November 2023. The inspection assessed the Partnership as being ‘Good’ (Grade 4) for all 5 indicators which were considered and provides clear direction on key areas for improvement. Item number: 5.9 Page 175 of 348
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Midlothian Integration Joint Board The report confirms that the Partnership’s structures and processes for risk management, resilience and major incident planning address the requirements of Midlothian Council and the Lothian NHS Board. This includes the maintenance of the Partnership’s Risk Register and processes which support the appropriate escalation of identified risks. Board members are asked to: • Discuss and approve the contents of this report Page 176 of 348
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Midlothian Integration Joint Board Midlothian Integration Joint Board Integrated Assurance Report 1 Purpose 1.1 This is the Integrated Governance report for Midlothian Integration Joint Board (IJB). 2 Recommendations 2.1 Board members are asked to discuss and approve the content of this report. 3 Background and main report 3.1 This report updates the IJB on the activity undertaken to provide assurance around the delivery of safe, effective, and person-centred care in Midlothian and the processes in place to cover risk and resilience. 3.2 Clinical Care and Governance and Assurance Structure and Processes The Clinical and Care Governance Group (CCGG) meets quarterly to enable assurance to be provided to the IJB around the safety, effectiveness, and person centredness of Midlothian Health and Social Care Partnership (MHSCP) services. Group Service, Service and Team Plans have been in place across the HSCP since April 2023. The associated rollout of the Governance and Assurance Framework and a review of meeting structures provide the CCGG with a complete picture of the assurance and any identified risks being reported across all services at every meeting. With the introduction of the Governance and Assurance Framework (GAF) and CCGG reporting template, discussions took place around the service level groups that form part of the governance structure. These groups formerly known as Quality Improvement Teams (QITs) have been renamed Quality Management Groups (QMGs) to reflect the wider quality activity to which the Partnership aspires. The QMGs report to the CCGG on the actions services undertake to address clinical and care governance, risk management, including quality planning, quality improvement activities, evidence of quality assurance and quality control. The QMGs provide an opportunity for teams within services to share learning and progress innovation. QMGs are expected to meet at least 4 times per year to provide a GAF submission and CCGG template quarterly and deliver an annual summary report. A reporting template collates information about actions in place relating to the learning arising from investigation of adverse events and complaints, implementation of actions around safety alerts, specific standards and guidance, improvement work, action plans arising from audit and inspection activity and any other service-specific issues which could have impact on the quality and safety of care the service provides. The Board was previously advised of work underway to refresh the assurance template to support a more streamlined and consistent approach across services. From July Page 177 of 348
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Midlothian Integration Joint Board 2023, the HSCP has been using the Governance and Assurance Framework adapted from the version tested by AHPs across Lothian (Appendix 1). Learning from each quarter, adaptations continue to be made to the tool and its reporting. The tool enables collaboration, shared learning and a visibility across the system of the current assurance levels. Focus will continue around learning from services and their experience, with revising and retesting of the GAF as required. Following refinements, an audit tool will be developed to assure the local processes associated and focus on continuous improvement. The introduction of the GAF prompted a review of the 6 Governance Groups that report to the Senior Management Team: Clinical Care and Governance, Integrated Workforce Governance Board, Finance and Performance, Business Governance, Digital Programme Board, and the Partnership Forum. Work continues to ensure that areas highlighted as medium of low assurance by services in the Governance and Assurance Framework are additionally reviewed by the relevant Governance Group (Appendix 1). Work will be undertaken to ensure that the Terms of Reference of the Governance Groups which report to the Senior Management have risk as a standing agenda item to reflect this. Although these updated systems and processes are at an early stage in implementation, clearer links between the clinical and care governance workstreams and the management of performance and resources are being made. There is a shared commitment to develop processes and approaches further to streamline reporting and provide assurance around the quality, safety and effectiveness of the services delivered and commissioned by the Midlothian Health and Social Care Partnership, ensuring all activities and tasks are delivered to a desired standard. The role of Chief Social Work Officer, which carries statutory functions, sits outwith the HSCP. The Head of Adult Services is now Deputy Chief Social Work Officer for Midlothian Council and therefore de facto acts as the lead Social Worker for the HSCP. The CSWO is a member of the IJB and pre-IJB meetings have been set up with the Chief Officer and Head of Adult Services to discuss any issues that may be particularly pertinent for professional social work. The QIT processes are integrated, and managers’ report on all HSCP business thus providing assurance regarding social work services. There remains a need to ensure the CSWO is linked in effectively to this structure. The combination of the newly constituted Social Work Assurance Group (SWAG) and the Governance and Assurance Framework will further strengthen this level of assurance. 3.3 The Clinical and Care Governance Group The Clinical and Care Governance Group meets on a quarterly basis. Since the last report to the IJB, meetings have taken place in April, July, and October. The HSCP’s annual report (Appendix 3) was presented at the September 2023 meeting of the NHS Lothian Healthcare Governance Committee and was positively received. 3.4 Investigating and Learning from Adverse Events and Complaints Three groups are established to provide oversight of all significant adverse events reported within Midlothian. Specific groups address in-patient falls at Midlothian Page 178 of 348
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Midlothian Integration Joint Board Community Hospital, and pressure ulcers. The Midlothian Safety and Experience Action Group (MSEAG) has oversight of all significant adverse events (adverse events which result in harm assessed as moderate or above), including the death or suicide of patients engaged with mental health and substance use services or unexpected medical deaths. This group commissions external reviews of major harm or death significant events in line with NHS Lothian protocols. The MSEAG minutes are submitted to the Lothian Patient Safety and Experience Action Group, and all Serious Adverse Events approved as complete in Midlothian require the approval of the NHS Lothian Medical Director and Executive Nurse Director before final closure. The HSCP Senior Management Team (SMT) receives a fortnightly report regarding performance around the management of complaints and the reporting and management of adverse events on the Datix system. Datix is a web-based tool which can be accessed by all NHS Lothian staff to report and learn from safety concerns such as actual adverse events and near misses. It helps in the collection and analysis of information to inform action plans which support safety and quality improvement. The system also provides modules to support the administration of Complaints, Claims and Service Management Team level Risk Registers, to provide an integrated information system. Quarterly oversight of themes and learning arising from complaints and adverse events has been added to the MSEAG agenda. At the time of writing 7 Significant Adverse Event (SAEs) are under investigation, one of those being an external review open more than 6 months. Charts 1 shows Midlothian reported and closed median are the same, preventing the development of a backlog. Chart 2 shows the Midlothian HSCP’s performance regarding SAEs open more than 6 months. 1 level 1 SAE has been open for over 6 months at the time of writing, and one other non-level 1 review has breached the 70 day target for its completion. Work continues to support actions that will enable local teams to address all adverse events within the Healthcare Improvement Scotland guidance timescales. SAE review performance against timescales has improved, and work is continuing to maintain performance and assure the quality of the reviews and the implementation of learning gained. Ongoing review of learning needs is undertaken and work with the Quality Improvement Support Team of NHS Lothian to enable appropriate learning opportunities to be identified and delivered. Outstanding actions from previously investigated Significant Adverse Events continue to be monitored by the MSEAG to ensure that they are completed. Chart 1 Midlothian Serious Adverse Events reported and closed at 4th December 2023 Page 179 of 348
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Midlothian Integration Joint Board Chart 2 Midlothian Adverse Events Open over 6 months at 4th December 2023 Page 180 of 348
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Midlothian Integration Joint Board Processes for Council services remain less mature around adverse events and work is outstanding to bring a degree of synergy to this. Ultimately, the aspiration is that MSEAG will manage all adverse events across the HSCP. Presently, there is scope to ensure all parts of the system are involved in SAEs where appropriate. This is most appropriate in relation to drug related deaths and suicides as it is not uncommon that staff from integrated teams are involved in such cases. Work is currently underway to develop an “adverse events” process for Social Work and Social Care services and this should be complete by early-2024. The newly constituted Social Work Assurance Group (SWAG) has brought a new layer of governance and assurance for all Social Work and Social Care services and, whilst this is still fairly new, it is already brining a degree of rigour previously absent. The Chief AHP is leading a review of processes and procedures relating to falls within Highbank Intermediate Care facility with a plan to develop a consistent and robust approach to falls risk assessment and management across all HSCP bed-based services. Revised processes for NHS complaints handling were implemented in June 2023. Performance against KPIs and an analysis of themes and learning from complaints.is monitored by MSEAG and reported to quarterly NHS Lothian performance review meetings. Charts 3 and 4 illustrate the numbers of upheld and partially upheld complaints with regard to NHS complaints processes in the Midlothian HSCP. The spike in August complaints was related to a number of complaints being received across a range of services. A particular increase in complaints received by our Mental Health and Substance Use Service has been noted. Chart 3: Number of Stage 1 complaints upheld/partially upheld Chart 4: Number of Stage 2 complaints upheld/partially upheld Charts 5 and 6 illustrate performance around Stage 2 complaints responses. Of 24 Stage 2 complaints received in the last 12 months, only 2 failed to meet the 20-day target for the provision of a response – this reflected the complexity of the complaints which involved a range of services, some of which are provided from other Directorates/Partnerships in NHS Lothian. At the time of writing Midlothian is involved in responding to 2 open complaints that are within KPI for responses. Page 181 of 348
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Midlothian Integration Joint Board Chart 5: % achievement of Stage 2 responses within 20-day KPI Chart 6: number of Stage 2 complaints responses out with 20-day KPI There is an opportunity to consider how learning from complaints and feedback across all of the HSCP has greater priority and visibility in relation to the work to improve the quality of experience and outcome for Midlothian residents. Complaints are generally managed through the respective organisations’ complaints handling processes and whilst processes and timescales are similar, there are also a range of Elected Member, MP and MSP enquires which tend to be funnelled through a Council route. Generally, these are managed by respective Heads of Service. 3.5 Clinical and Professional Oversight of Care Homes The Scottish Government published My Health, My Care, My Home - Healthcare Framework for Adults Living in Care Homes in June 2022. An Advice Note on Enhanced Collaborative Clinical and care Support for Care Homes issued on 14 December 2022 provides guiding principles and a framework to continue cross sector work to continue to improve the health and wellbeing of people living in care homes. Work is continuing on a Midlothian and Lothian basis to ensure these recommendations are met and that partners involved in the delivery of care home services are engaged in shaping the model going forward. The approach will be evolving and iterative, recognising that the role of the HSCP is different to that of the inspection and regulation responsibilities of the Care Inspectorate. 3.6 Inspections The Clinical and Care Governance Group maintains oversight of the inspections undertaken by regulatory bodies, including the monitoring of action plans for improvements. Managers log service inspection reports with their QMG submissions. Page 182 of 348
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Midlothian Integration Joint Board The Care Inspectorate and Healthcare Improvement Scotland share a common aim that the people of Scotland should experience the best quality health and social care. They work together to deliver programmes of scrutiny and assurance activity that look at the quality of integrated health and social care services and how well those services are delivered. The joint inspection of adult services with a focus on integration and outcomes for people with physical disabilities, long term conditions and their carers commenced in May of this year. In July, the partnership submitted a ‘Position Statement’ which sought to benchmark activity against the five quality indicators outlined by the Care Inspectorate and Health Improvement Scotland. Narrative and evidential documents were provided to support statements relating to how the partnership is evidencing outcomes, commissioning services, and developing key processes to support people accessing our services to have positive experiences. In parallel with the partnership’s written contribution, the Care Inspectorate and Health Improvement Scotland completed engagement activity with people and their carers, staff from third sector organisations and a range of professionals from within the Partnership. The scrutiny activity was concluded with the publication of the final report on 28th November 2023 (Appendix 4). This report outlines scrutiny themes and findings against 5 key indicators including ‘leadership and direction’ and the ‘experiences of people accessing our services’. The overall conclusion of the report assessed the Partnership as being ‘Good’ (Grade 4) for all 5 indicators assessed. Some of the key strengths that were identified include people with physical disabilities and complex needs had positive experiences of integrated and person-centred health and social care which supported an improved quality of life. Evidence showed that there was a positive and effective approach to early intervention and prevention across the Partnership and that this was prioritised across the workforce. There was also acknowledgement around the partnership embedding a strengths-based outcomes approach to planning, delivery, and evaluation of its services. Priority areas for improvement included a continued need to address support for carers, to ensure an integrated approach to providing information and advice around support, care and treatment whilst continuing to support staff to be more confident in their knowledge of self-directed support. The learning from the inspection will be collated within an improvement plan and shared, monitored, and reviewed by the Care Inspectorate throughout 2024. Intimation has also been given that an Inspection of the Partnership’s delivery of Adult Support and Protection will be undertaken in Spring 2024. Through the QMGs, we have developed a more systematic approach to managing recommendations from Mental Welfare Commission themed reports. Generally, such reports have a range of actions for Scottish Government, NHS Boards and HSCPs. These are worked into an Action Plan for later submission back to the Mental Welfare Commission. Governance is provided by reports coming to the HSCP SMT and the Social Work Assurance Group (where appropriate). 3.7 Risk Management Midlothian HSCP is compliant with the NHS Lothian Risk Management Policy and Midlothian Council Risk Management Policy and Strategy. The Risk Management Page 183 of 348
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Midlothian Integration Joint Board process within Midlothian was audited in 2021 and the finalised report confirmed that the Risk Management processes within Midlothian provided high assurance and demonstrated best practice in several areas: • Midlothian HSCP Senior Management Team meet every 2 weeks and risk is a standing agenda item. • Service level risks registers are locally managed, and oversight is held by Heads of Service for review and escalation to the Senior Management Team (if required). • Risks are routinely monitored through these escalating levels with additional risk oversight held by Midlothian Council and Midlothian IJB both strategically and operationally. • Each risk recorded either operationally or strategically have actions associated to mitigate the risk, these are routinely monitored through the appropriate level of monitoring as mentioned above. • Each risk has a risk owner identified who is the accountable person for managing the related actions and providing routine updates on the status of the risk. 3.8 Resilience and Major Incident Planning Midlothian Health and Social Care Partnership supports its partner organisations, NHS Lothian and Midlothian Council, to deliver their obligations as responders to major incidents. The Partnership provides Midlothian IJB with any relevant assurance in relation to incident management and response which supports its responsibilities as a Category 1 responder. Midlothian Health and Social Care Partnership maintains major incident plans in line with NHS Lothian’s Resilience Policy and provides assurance through NHS Lothian’s reporting cycle on resilience, major incident planning and business continuity. A virtual control room is in place for incident management along with physical control rooms in both Midlothian Community Hospital and Fairfield House. Service Managers are required to review and update their service-specific resilience and business continuity plans annually which feed into the overarching Midlothian Resilience Plan. 3.9 Risk Register Operational risks are captured in the Partnership Risk Register, which is updated and reviewed regularly, and when required escalated to the NHS Lothian Corporate Risk Register and Midlothian Council Strategic Risk Profile. HSCP mitigation plans contribute to the overarching corporate risk registers held by NHS Lothian and Midlothian Council. The following risks on the NHS Lothian Corporate Risk Register are relevant to the Midlothian HSCP: • 4 Hours Emergency Access Target • Hospital Bed Occupancy • Sustainability of Model of General Practice Page 184 of 348
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Midlothian Integration Joint Board 4.0 Policy Implications 4.1 This report should provide moderate assurance to the IJB that relevant clinical and care governance policies are appropriately implemented in Midlothian, and that appropriate mechanisms are in place to assess and manage risk and ensure service resilience. 5.0 Directions 5.1 Clinical and care governance and risk management and resilience planning are implicit in various directions that relate to the delivery of care. 6.0 Equalities Implications 6.1 The new Governance and Assurance Framework requires services to provide assurance that they are complying with the Equalities duties including the completion of Integrated Impact Assessments (IIA’s) where necessary. It is anticipated that this will strengthen the ability for the HSCP to comply with its equality duties. 7.0 Resource Implications 7.1 Resource implications are identified by managers as part of service development. and additional resource may at times be required to ensure required standards of clinical and care governance, risk management and resilience planning are met. The expectation is that these activities are embedded in service areas and teams and that staff have time built in to attend the relevant oversight groups and undertake the associated responsibilities. 8.0 Risk 8.1 This report is intended to keep the IJB informed of governance arrangements and any related risks and to provide assurance to members around improvement and monitoring activity. 8.2 All risks associated with the delivery of services are monitored by managers and where appropriate they are reflected in the risk register. 9.0 Involving people 9.1 Midlothian staff are involved in the development and ongoing monitoring of processes related to clinical and care governance and risk identification, assessment, and management. 9.2 Public representatives on the IJB will have an opportunity to provide feedback and ideas. Page 185 of 348
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Midlothian Integration Joint Board 10.0 Background Papers 10.1 My Health, My Care, My Home – Healthcare Framework for Adults Living in Care Homes in June 2022 - My Health, My Care, My Home - Healthcare framework for adults living in care homes (www.gov.scot) AUTHOR’S NAME AND DESIGNATION Fiona Stratton, Chief Nurse Claire Ross, Chief AHP Nick Clater, Head of Adult Services Grace Cowan, Head of Primary Care and Older People’s Services, and Roxanne King, Executive Business Manager CONTACT INFO Fiona.Stratton@nhslothian.scot.nhs.uk claire.l.ross@nhslothian.scot.nhs.uk Nick.Clater@midlothian.gov.uk Grace.Cowan@nhslothian.scot.nhs.uk roxanne.king@nhslothian.scot.nhs.uk DATE 4th December 2023 Appendices: Appendix 1: Midlothian Integrated Governance and Assurance Framework Escalation Routes Appendix 2: Midlothian HSCP Governance and Assurance Framework Appendix3: Midlothian HSCP Annual Report to NHS Lothian Healthcare Governance Committee Appendix 4: Midlothian Joint Inspection of Adult Services Report Page 186 of 348
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Appendix 1: Midlothian Integrated Governance and Assurance Framework Escalation Routes Domain Measure Escalation Route Safe Adverse Events Clinical Care & Governance &/or Business Governance Duty of Candour Clinical Care & Governance Health and Safety Clinical Care & Governance &/or Business Governance Workforce Management Workforce Governance (Access and Demand) Effective Core Mandatory Training Workforce Governance (Staff Engagement & Development) &/or Clinical Care & Governance Personal Development (including PDR/MPM) Workforce Governance (Staff Engagement & Development) &/or Clinical Care & Governance Supervision Workforce Governance (Staff Engagement & Development) &/or Business Governance &/or Clinical Care & Governance Service Performance & Quality Indicators Any Group (defined by KPI) Finance / Resources Finance & Performance &/or Business Governance Change Management Processes Partnership Forum &/or Clinical Care & Governance Person- Centred Complaint Management Clinical Care & Governance &/or Business Governance Service User Experience & Engagement Workforce Governance (Staff Engagement & Development) &/or Clinical Care & Governance &/or Business Governance Regulatory Professional Body Registration Workforce Governance (Staff Engagement & Development) &/or Clinical Care & Governance Staff Performance Management Workforce Governance (Staff Engagement & Development) &/or Clinical Care & Governance External Compliance or Audit Clinical Care & Governance &/or Business Governance Page 187 of 348
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Midlothian Integration Joint Board Thursday 21st December 2023, 14:00-16:00 Midlothian Drug Misuse and Alcohol Specific Deaths 2022 Executive summary Midlothian and East Lothian Drugs and Alcohol Partnership (MELDAP) is the local Alcohol and Drugs Partnership (ADP). MELDAP aims include: • Reduce the harm to individuals and promote recovery from substance use • Protect children and young people from the effects of parental substance use • Promote early intervention to prevent the harmful use of alcohol and drugs • Develop high quality services responsive to the changing needs of people who use and need our services. This report highlights pertinent areas relating to Drug Misuse and Alcohol Specific Deaths in Midlothian for 2022, to accompany a presentation for Board consideration. Board members are asked to: • Note the content of this report, # Item number: 5.10 Page 227 of 348
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Midlothian Integration Joint Board Midlothian Integration Joint Board Midlothian Drug Misuse and Alcohol Specific Deaths 2022 1 Purpose 1.1 This report is to brief the Integrated Joint Board (IJB) on Drug Misuse and Alcohol Specific Deaths in Midlothian covering the period of 2020 to 2022. 2 Recommendations 2.1 IJB Members are being asked to note the content of this report. 3 Background and main report 3.1 Drug Misuse Deaths 2022. In Midlothian there was a significant reduction from 23 in 2021 to 4 in 2022. 3.2 Please see below the 2022 data for Scotland and the 4 Integrated Joint Board (IJB) areas against that of 2021: 3.3 However, to put Midlothian’s information for 2022 in context, in July 2023, in Midlothian, there were 4 sudden deaths that may have been related to drug use. This is an example of the unpredictability of drug use, drug ‘quality’, and availability in Midlothian. 3.4 Highlighted Actions 3.4.1 The Midlothian Substance Use Service (MLSUS) and Mid and East Lothian Drugs [MELD] as part of MELDAP services are meeting the Medication Assisted Treatment (MAT) Standards 1 to 5 as required by the Scottish Government. These focus on providing same day start for people seeking Opiate Substitute Therapies and ensuring an increased level of choice of medication within the service including delivering Buvidal (an injectable slow-release dose of the opiate Buprenorphine), and implementing MAT standards 6-10. MAT Standards 6- to 10 focus on the Drug Misuse Deaths Scotland Midlothian East Lothian West Lothian City of Edinburgh All 1051 (-279) 4 (-19) 17 (+1) 32 (-) 113 (+4) Males 692 (-241) 2 (-14) 12 (-) 22 (-1) 82 (+3) Females 359 (-38) 2 (-5) 5 (+1) 10(+1) 31 (+1) Page 228 of 348
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Midlothian Integration Joint Board delivery of psychological support, advocacy, and provision of treatment in Primary Care settings. 3.4.2 Midlothian Substance Use services provided assertive outreach to people who have experienced non-fatal overdose with range of interventions including support into treatment offered. 3.4.3 MELDAP has increased the resourcing and coverage of Naloxone (A medication which temporarily reverses the effects of opiate overdose). 3.4.4 MELDAP has increased the number of Safe Storage Boxes for people to safely store prescribed medications within their household. 3.4.5 MELDAP funds an independent advocacy response provided by CAPS. Additional advocacy support is provided by Access to Industry. 3.5 Alcohol Specific Deaths 2022 In Midlothian there was a slight reduction in the numbers of those who passed away from 18 in 2021 to 17 in 2022. 3.6 Please see below the 2022 data for Scotland and the 4 Integrated Joint Board (IJB) areas against that of 2021. Scotland Midlothian East Lothian West Lothian City of Edinburgh 1276 (+31) 17 (-1) 19 (+7) 24 (-16) 93 (-9) 3.7 Highlighted Actions 3.7.1 The Midlothian Substance Use Service (MLSUS) and Mid and East Lothian Drugs (MELD) provide direct access to treatment and support for those affected by their or others alcohol use. 3.7.2 Edinburgh and Lothian Council on Alcohol (ELCA) provide an alcohol counselling service in Midlothian. 3.7.3 There is now a pilot low threshold café in Penicuik. The focus in this service is to encourage those not in alcohol and drug treatment to accept support in a café setting with the aim of supporting them to enter treatment and recovery services. 3.7.4 The MELDAP Recovery College provided by Access to Industry offers assistance into education and employment. 3.7.5 In relation to prevention activities, MYPAS provide support to young people affected by their own alcohol and drug use. They offer one to one support/key working and group work opportunities. Page 229 of 348
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Midlothian Integration Joint Board 4 Policy Implications 4.1 The actions noted above are delivered as part of our local response to meet elements of Scottish Government priorities and national drugs policy (Rights, Respect and Recovery and Strategies for Preventing Drug-Related Deaths in Scotland: Our Emergency Response) as well as the MELDAP Delivery Plan 2020- 23. 5 Directions 5.1 This report does not directly impact upon service ability to deliver existing Directions. 6 Equalities Implications 6.1 There are no direct equalities implications arising from this report. 7 Resource Implications 7.1 There are no resource implications as the work of services and the partnership is within financial resources. 8 Risk 8.1 No risks identified. 9 Involving people 9.1 MELDAP has engaged with a number of partner organisations to deliver services and responses to engage people that use drugs and or alcohol into treatment and recovery. 10 Background Papers 10.1 N/a. AUTHOR’S NAME Nick Clater DESIGNATION Head of Adult Services CONTACT INFO Nick.Clater@midlothian.gov.uk DATE 21st December 2023 Appendices: N/a. Page 230 of 348
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Midlothian Integration Joint Board Thursday 21st December 2023, 14:00-16:00 Midlothian and East Lothian Drugs and Alcohol Partnership (MELDAP) Annual Reporting Survey Report 2022/23 Executive summary Midlothian and East Lothian Drugs and Alcohol Partnership (MELDAP) is the local Alcohol and Drugs Partnership (ADP). As such MELDAP is required to report on an annual basis on aspects of service delivery and ministerial priorities as directed by the Scottish Government. This report highlights pertinent areas to the Midlothian Integration Joint Board (IJB) and relates to the actual Annual Reporting Survey, which was submitted to Scottish Government in July 2023, with the survey attached (see appendix 1) for review. Board members are asked to: • Note the contents of the MELDAP Annual Reporting Survey 2022/23 # Item number: 5.11 Page 231 of 348
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Midlothian Integration Joint Board Midlothian Integration Joint Board Midlothian and East Lothian Drugs and Alcohol Partnership (MELDAP) Annual Reporting Survey Report 2022/23 1 Purpose 1.1 This report is to brief the Integrated Joint Board on the MELDAP Annual Reporting Survey for 2022/23 submitted to the Scottish Government in July this year. 2 Recommendations 2.1 IJB Members are being asked to note the content of this report. 3 Background and main report 3.1 The report format and requirements have changed significantly over the last few years. This reflects the focus on the undertaking of other specific requirements related to the National Drugs Mission and Implementation of the 10 Medication Assisted treatment (MAT) Standards. 3.2 Most of the Annual Reporting Survey is designed to allow ADP’s to “check” boxes to confirm what is in place in the ADP area. 3.3 Scottish Government required responses in the following areas. • Surveillance and Data Informed • Resilient and Skilled Workforce • Lived and Living Experience • Stigma Reduction • Fewer people develop problem substance use • People most at risk have access to treatment and recovery. • People receive high quality treatment and recovery services. • Quality of life is improved by addressing multiple disadvantages. • Children, families, and communities affected substance use are supported. Specific areas to highlight for the IJB are: 3.4 All MELDAP funded peer workers have Lived/Living Experience (LLE). MELDAP also funds the Midlothian Family Support Group run by people with lived and living experience and/or supporting a child/partner who has experienced issues relating to their substance use. Work has started to engage with different groups/recovery community to establish what a LLE panel is, what it should do, membership and links to MELDAP Strategic Group etc. Page 232 of 348
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Midlothian Integration Joint Board 3.5 MELDAP funds two services run by Circle and Children 1st. Both services adopt a whole family approach and offer family inclusive practice. Both services have family peer support workers with lived experience. 3.6 MELDAP has a series of Quality Improvement visits to all services supported by an agreed agenda. For the current round of visits one of the themes is how services collect in a planned, systematic way the views of people who use their service: children, young people, adults, and families. When services present to the Commissioning and Performance Group, they are encouraged to include participation by people who have used their service. MELDAP has also produced Know Your Rights poster explaining the 10 MAT standards. MAT 2 is the 'right for family to be involved in a person's treatment. These posters have been widely distributed. MELDAP is about to undertake a series of consultation events, some will involve family members, on the design of services for the next 3-5 years, as well identifying priorities for the next Delivery Plan. 3.7 Two commissioned services provide opportunities for families to be involved in training/development, for example, Parents Under Pressure, Naloxone training. MELDAP also funds Anam Cara, Women's Supper Club, the Recovery College, and the Midlothian Family Support Group. 4 Policy Implications 4.1 Both the Annual Reporting Survey and the highlighted areas noted in Section 3 evidence the requirements of meeting elements of Scottish Government priorities and national drugs policy (Rights, Respect and Recovery) as well as the MELDAP Delivery Plan 2020-23. 5 Directions 5.1 This report does not need a new direction and has no implications for current directions. 6 Equalities Implications 6.1 There are no direct equalities implications arising from this report. 7 Resource Implications 7.1 There are no resource implications as the work of services and the partnership is within financial resources. 8 Risk 8.1 No risks identified. 9 Involving people 9.1 The services funded by MELDAP were involved in providing data and outcomes for the Annual Reporting Survey. The survey itself was unanimously approved by the Page 233 of 348
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Midlothian Integration Joint Board MELDAP Strategic Group before it was submitted to the Scottish Government under very tight timescales. 10 Background Papers 10.1 N/a AUTHOR’S NAME Nick Clater DESIGNATION Head of Adult Services CONTACT INFO Nick.Clater@midlothian.gov.uk DATE 21st December 2023 Appendices: Appendix 1: MELDAP Annual Reporting Survey Report 2022/23 Page 234 of 348
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Midlothian Integration Joint Board Thursday, 21st December 2023, 14:00-16:00 Midlothian Community Payback Annual Report 2022-2023 Executive summary The Community Payback Order (CPO) was introduced under the Criminal Justice and Licensing (Scotland) Act 2010 and came into effect on 1st February 2011. It replaced a number of community-based sentences that had been available to the court until then such as Probation Orders and Community Service Orders. The legislation that had governed these disposals, the Criminal Procedure (Scotland) Act 1995 (the 1995 Act), was amended by the Criminal Justice and Licensing (Scotland) Act 2010. Section 227ZM of the Criminal Procedure (Scotland) Act 1995 imposes a duty on local authorities to submit annual reports on the operation of the CPO. Each Local Authority area submits their annual report to Community Justice Scotland who prepare a summary report which will be led before Parliament by 31st March 2024, in accordance with the 1995 Act, and then published online. A CPO may include one or more requirements: *Supervision, *Unpaid work or other activity, Programme, Compensation, Residence, Mental health, Drug Treatment, Alcohol Treatment, Conduct and Restricted movement (electronic monitoring). It can be made for a period between 6 months and 3 years, other than when it consists solely of an unpaid work or other activity requirement in which case it must be completed within 6 months unless the court determines otherwise. * These are the only 2 requirements that can be standalone. The other requirements must have supervision included also. This report is a summary of the 2022-2023 CPO Annual Report. Members are asked to: • Note the contents of the report. # Item number: 5.12 Page 259 of 348
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Midlothian Integration Joint Board Midlothian Integration Joint Board Midlothian Community Payback Order Annual Report 2022-2023 1 Purpose This report sets out the activity carried out by the Midlothian Justice Service as part of the supervision and management of those subject to a Community Payback Order (CPO) during 2022/2023. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the contents of the report. 3 Background and main report 3.1 The requirement for ‘annual reports on community payback orders’ is outlined in section 227ZM of the Criminal Procedure (Scotland) Act 1995 (the 1995 Act). The report is submitted, as soon as practicable, after the end of each reporting year on the operation of Community Payback Orders within the Local Authority area. The “reporting year” means a year ending on 31st March. 3.2 Key points from the report: How we address offending behaviours and the risk of re-offending: The majority of people the Justice Service work with have experience/are experiencing issues such as inequality, adverse childhood experiences, trauma, lack of opportunity, poor physical and mental health issues and difficulties with accessing education/employment and substance use. Interventions are person-centred and trauma informed to enable clients to identify and achieve positive outcomes. Staff access relevant training in risk assessment and interventions and in the reporting year this included all staff undertaking training in Motivational Interviewing and Decider Skills. Decider Sills teaches people the skills to recognise their thoughts, feelings and behaviours, enabling them to monitor and manage their own emotions and mental health. How we address underlying needs: The Justice Service are co-located within a Recovery Hub (No 11) alongside community-based substance use and mental health services and third sector partners. Whilst on a CPO the Justice Service is the lead agency but work in partnership to meet the needs of the individual, using person centred and strengths-based approaches, to enable positive outcomes for individuals, including identification of suitable rehabilitation services. Impact of being on CPO with a Supervision Requirement: Research indicates that a strong therapeutic alliance between a person and their practitioner is a key Page 260 of 348
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Midlothian Integration Joint Board factor in the success of an intervention. We collate feedback from the individuals that we work with as this enables us to work collaboratively and to improve service delivery. The feedback from service users reflects this; even when the actions of the service user required the practitioner to return the order to court in breach. How unpaid work benefits communities and those on a CPO with Unpaid Work or Other Activity: In the reporting year the Unpaid Work team completed 278 projects which benefited 221 people. We collated feedback from beneficiaries at the end of a project and 100% of respondents reported that the quality of the work was good (3%) or excellent (97%). From the feedback provided by individuals on an order, 100% of those who completed unpaid work or other activity advised that they learnt new skills and had been able to make reparation for their offending behaviour. Partnership working with statutory and non-statutory partners: The Justice Service works closely with third sector partners to ensure that those subject to a CPO can access local resources. We continue to fund a Peer Co-Ordinator through Health in Mind to ensure that involved in the justice system can access support and mentoring from those with similar lived experience. The Justice Service are co-located with statutory and non-statutory services within No 11 to ensure that there are clear pathways and reduced barriers to engagement for those experiencing mental health or substance use issues. The Justice Service work closely with the partner agencies within the Multi-Agency Public Protection Arrangements (MAPPA) and access consultation and assessment provided by Forensic Psychiatrist and Forensic Psychologists from the Serious Offender Liaison Service (SOLS). These frameworks support staff in the robust management of registered sex offenders and those assessed as posing a high risk of harm to others. 4 Policy Implications 4.1 There are no direct policy implications arising from this report. 5 Directions 5.1 This report is for the financial year 2022-2023 and I have referenced the relevant directions for that period. 5.2 MIJB 13.5 relates to the delivery of CPOs: Prevent the risk of further offending by improving interventions with people who are on/ have completed a Community Payback Order. 5.3 There is no impact on our ability to complete current directions. The Justice Service works the partnership in achieving the Health and Wellbeing Outcomes in particular the following Directions: 1.1, 2.1, 2.2, 3.3 and 4.1. Current service objectives include: • Services will work collaboratively to ensure that they are delivering effective interventions • Justice service ensures that service users are integrated into their local community and able realise their potential • Services support rehabilitation, use custody only where there is no alternative and work to reduce reoffending and re-victimisation Page 261 of 348
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Midlothian Integration Joint Board 6 Equalities Implications 6.1 An Inequalities Impact Assessment has been completed (appendix two). 6.2 The Justice Service utilises information from a range of sources, including the HSCP Joint Needs Strategic Assessment and Justice Analytical Services (Scottish Government) to ensure that the work undertaken meets the needs of those from the area and those who have been affected by crime. 7 Resource Implications 7.1 There are no resource implications arising from this report. 8 Risk 8.1 The main risk associated with the delivery of Community Payback Orders remains the Courts and the wider public having the confidence in the effectiveness of CPOs in reducing the risk of harm and of re-offending. 9 Involving people 9.1 The Justice Service ensure that the needs of the local community are considered, and we achieve this through seeking feedback from beneficiaries and those involved in the Justice system. 9.2 Justice Social Work include service users in the recruitment of Justice staff through a lived experience recruitment panel. Candidates who have successfully passed the screening and formal interview panel process meet with the service user panel for an informal interview. Feedback on this process has been positive from both interviewees and panel members. 9.3 The Community Justice (Scotland) Act places a duty of co-operation on community justice partners to work together to plan and decide how services are tailored locally. Consultation remains key to the work undertaken by Community Justice Partnership and over the reporting year a variety of methods have been used to ensure that community voices are captured to support development and delivery of service provision. The Justice service is one of the agencies within the partnership. 10 Background Papers 10.1 Should further information be required the following papers can be provided on request: Midlothian Community Payback Annual Report 2021-2022; Community Justice Scotland: Summary of Local Authority Reports 2021-2023 and Scottish Government: Community Payback Order (Practice Guidance). AUTHOR’S NAME Julie Jessup DESIGNATION Interim Service Manager (Justice and Protection Services) CONTACT INFO Julie.jessup@midlothian.gov.uk 07557317112 Page 262 of 348
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Midlothian Integration Joint Board DATE 24th October 2023 Appendices: Appendix One: Midlothian Community Payback Order Annual Report 2022-2023 Appendix Two: CPO Delivery Integrated Impact Assessment Page 263 of 348
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COMMUNITY PAYBACK ORDER ANNUAL REPORT FINANCIAL YEAR: 2022/23 LOCAL AUTHORITY: Midlothian Page 265 of 348
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2 1) In this section, please give examples of work with people subject to CPOs specifically to address offending behaviours and the risk of reoffending. (Bullet points will suffice. Max 300 words.) The majority of people we work with have experienced/experience issues such as inequality, adverse childhood experiences, trauma, lack of opportunity, poor physical and mental health issues and difficulties with accessing education/employment and substance misuse. The approaches we use are person-centred and trauma informed to ensure we enable clients to identify and achieve positive outcomes. We ensure that staff access relevant training in risk assessment and interventions; in the reporting year this included all staff undertaking training in Motivational Interviewing and Decider Skills. Decider Sills teaches people the skills to recognise their thoughts, feelings and behaviours, enabling them to monitor and manage their own emotions and mental health. Working with Women: The Spring Service is for women involved in, or at risk of becoming involved, in the formal justice system. It provides structured interventions and is delivered in partnership with NHS Lothian, Public health, Women’s Aid, Access to Industry, Health in Mind and Social Work. The Spring Service has three elements: • One to one work to prepare for group • Structured 12 week programme • Holistic health and wellbeing sessions (led by nurse and OT) Women attending will be supported and have access to a range of different professionals including Social Workers, a registered Nurse and Occupational Therapist, along with other workers with backgrounds in mental health and gender-based violence. Working with Men: We have continued to review and develop service delivery to men aged 18-26 years of age. This is to ensure that issues related to transition to adult services, consideration of maturation and impact of trauma and Adverse Childhood Experiences are taken into account and that relevant supports and interventions are available for those subject to a CPO with supervision. Recruitment impacted on our ability to run groups consistently during the reporting year. Programme Requirements: We continue to provide access to accredited programmes for those convicted of offences of a sexual or domestically abusive nature. These interventions address underlying values and attitudes including their thoughts and behaviours which led to them offending. Both can be delivered on an individual and group work basis. 2) In this section, please give examples of work with people subject to CPOs specifically to address their underlying needs (e.g. mental health needs, substance use needs). (Bullet points will suffice. Max 300 words.) The Justice Service are co-located within a Recovery Hub (No 11) alongside community-based substance use and mental health services and third sector partners: Health in Mind, Penumbra, MELD and CGL. The benefits of integrated working is a 'No wrong door approach' as an individual can access one of the services within No 11 but is identified with other health and well-being needs. Services work collaboratively which improves the individual's experience and journey. Whilst on a CPO the Justice Service is the lead agency but works in Page 266 of 348
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3 partnership to meet the needs of the individual, using person centred and strengths-based approaches, to enable positive outcomes for individuals, including identification of suitable rehabilitation services. For clients who do not require medially assisted treatment, support and access to resources is provided through collaborative working with MELD and CGL. CGL and MELD work with those who advise of lower-level problematic substance use. During the reporting year we have continued too work with agencies including Veterans First Point and FAST to ensure that we can effectively address underlying issues which may otherwise have been a barrier to effective engagement. 3) In this section, please give a summary of feedback, may include quotes, from people subject to CPOs about the impact on them of a Supervision Requirement. (Bullet points will suffice. Max 300 words.) The following quotes have been taken from reviews of progress, for those subject to a CPO with Supervision or both Supervision and Unpaid work. What is clear is the importance of the relationship between the worker and the client. Clear boundaries and effective communication underpin the development of the relationship, enabling staff to maintain the integrity of an order through appropriate use of disciplinary and breach proceedings alongside supporting a client to complete their order. • ‘My worker breached me but explained the process and that if I attended voluntarily the Court might be ok with it. I did and got through the order.’ • “I found (my worker) a good person. They seemed interested in me and listened. I know I’m not the easiest person to be around but they helped me realise that I can deal with it.” • “They were right. No one taught me how to deal with all this in the past, now I can learn from it and not try to lose myself in whatever I could find to take” • Service user using Phoenix Futures whilst on a CPO advised – “I needed out. Out of where I lived, away from all my so called friends. Every time I tried to stop I got dragged back in. Once I got there I could focus on me and my recovery” • “If I hadn’t had your support, I’d be in prison…..She [social worker] makes me feel worth something” • “oh aye, I have don’t not too bad eh?......Spring helped me to manage how I am feeling. I still get raging but I can manage it better. Calm myself down faster now”. • “continue to attend on my CPO to talk through the problems I have and my progress in managing my ADHD ………. I have never had this opportunity before. It will help me to remain out of trouble and stop offending”. • When reflecting on the support received to manage alcohol and drug use and to make better decisions in relation to peers and use of time he reported: “it is a definitely a vast improvement on my life and I feel a lot more in control” • “communicating with people better and changing my lifestyle” as the reasons for achieving desistance. He asked if being on the current order was helpful and said yes “I can reflect on my progress and it keeps me on the straight and narrow”. 4) In this section, please report on the following: ▪ Types of unpaid work projects carried out ▪ Example(s) that demonstrate(s) how communities benefited from unpaid work (Bullet points will suffice. Max 300 words.) Page 267 of 348
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4 The Midlothian Unpaid Work team continues to undertake projects in house and in partnership with community groups and charities to target and support communities who are most impacted by crime. In the reporting year we completed 278 projects benefitting 221 beneficiaries, including: • Uplifts and removals supporting the Mental Health Team to declutter the home of a person with hoarding tendencies • Supporting a Community Group that supports children with disabilities, their families and carers. This involved assisting access to local foodbanks, working with charity shops to help provide weather appropriate clothing and footwear, clearing gardens to allow access and general maintenance tasks within homes • Supporting a local gardening group improve green areas and shared spaces. This included heavy lifting to support volunteers in laying slabs and completing regular garden maintenance • Continuation of Annual Waste Amnesty project, in the build up to bonfire night, targeting Midlothian’s 3 highest areas of unregulated fires. We completed 107 uplifts for 395 combustible items being removed and recycled. The Scottish Fire and Rescue Service reported a reduction in unsolicited fires attributed this to our work • Preparing and delivering food parcels to support a local foodbank. We are developing a project with the foodbank to meet demand for furniture and whitegoods. By recycling items from our annual waste amnesty and donations to the foodbank we have prevented items going to landfill and upskilled clients with skills in furniture recycling and learning to PAT test electrical equipment. Members of the community most in need have benefited by being able to access household furniture and electrical items. Category of Beneficiary Disability 37.9% Mental Health 13.9% Charity 13.9% Social Work Involvement 12.1% Elderly 8.3% Community Group 7.1% Other 5.6% Victim of Crime 0.9% Homeless 0.3% Total 100.0% Type of project undertaken Uplift, move, removal type work 50.7% Gardening 27.7% Multiple types of work 16.2% House Clearance 2.2% Painting 1.8% Fixtures and Fittings 0.7% Not specified 0.7% Total 100.0% 5) Summary of feedback, may include quotes, from people subject to CPOs about the impact on them of an Unpaid Work Requirement. (Bullet points will suffice. Max 300 words.) It is positive that 100% of clients who completed an Unpaid Work requirement reported they learned new skills and been provided with the opportunity to make reparation for their offending. Examples of feedback: • “I enjoy helping people out, my mum doesn’t get out about much so I can see how it can really help people”. • “it’s been gruelling at times. But I’ve enjoyed it more than I thought”. When we discussed his pom-pom making for the hats for babies at the Simpson maternity unit “Now that was really rewarding. I’m really proud of that … totally worthwhile”. Page 268 of 348
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5 • “you think you have a tough life but then seeing how many people need help made me think that my life is not bad. It was good to help people who had nothing.” • “the work I done made a difference to someone” and “made me feel acknowledged” • “I’ve done a bit of everything from pickups for the bonfires to collecting food for foodbanks. What I am doing is helping other people. I have not worked in 10 years and his is helping me to get back into a work routine by getting me up and out early”. • “Its not like my last Community Service. This time I am actually making a difference. The old guy with mental health problems had no one. I helped clear his house and went home feeling good.” • “I was visiting my granny in hospital and I showed my mum the garden that I was doing my CS in. She was happy seeing how nice the garden was. I saw somebody sitting on the bench looking at where I had been working. I felt proud that they were enjoying what I had done.” 6) What are the main types of ‘Other Activity’ carried out as part of an Unpaid Work Requirement? You may want to comment on the impact of completing Other Activities, for individuals or for the community. (Bullet points will suffice. Max 300 words.) As part of the ‘Other Activity’ service users can achieve qualifications. The Health and Safety induction is delivered by Unpaid Work supervisors following an accredited SCQF Level 4 syllabus. Clients can achieve the qualification through assessment at the end of the induction. We have issued 85 Level 4 awards to clients. Clients can also achieve advanced Health and Safety training and First Aid qualifications, and 90 clients completed their awards in the reporting year. One of our Supervisors has started SVQ Assessors qualification and is supporting two clients through SVQ Level 2 in Work Skills; this allows clients to use their experience on placement to undertake learning and reflective tasks to gain the SVQ qualification. Our train and learning pathways allow clients to gain confidence in a supported environment. This approach breaks down barriers that may have prevented clients from entering a more formal education setting. Our aim is to enable our clients to gain qualifications to help obtain employment and allow them to engage in further education with external providers to continue their learning journey. We work closely with Community Lifelong Learning Team (CLL) to access courses and undertake a variety of training including: Adult Achievement Award, CSCS Card, Digital Skills, An Introduction to Wellbeing and to undertake work improving their literacy and numeracy Skills. 7) Summary of feedback, may include quotes, from beneficiaries about the impact of Unpaid Work on the community. (Bullet points will suffice. Max 300 words.) Beneficiaries of projects are asked to complete feedback forms on completion of the project. Of the 278 projects undertake we received feedback from 156 beneficiaries: • 100% of respondents described the quality of the work as Good (3%) or Excellent (97%) • 100% said they were treated with respect by the clients. • 100% felt that the work had benefited the community and allowed the clients to make reparation for their crimes. • 97% said there were no improvements that they would like to see to the service with 3% said improvements could be made but they did not provide details. Page 269 of 348
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6 Quotes from Beneficiaries include: • “Very respectful of belongings. Spent appropriate time to say hello.” • “They worked there socks off.” • “This is an exceptionally large piece of work and is still ongoing however to date the work undertaken by the Unpaid Work Team has been incredible. The pace, the consistency and the interaction with my client to date has been nothing short of excellent.” • “The team have been very supportive and respectful to me during a hard tie (sic). They have lifted a worry off of me and helped to do the work in a quick and easy way for me.” • “My client has commented on xx’s (UPW supervisor) approach and has advised that he has been brilliant. He has been encouraging and motivating and I cannot honestly thank him and his team enough for this. This client has not engaged with anyone historically so for xxx (client) to now not only engage with myself weekly but xxx (UPW supervisor) and his team is testament to xxx’s (UPW Supervisor) hard work. xxx (UPW Supervisor) has also provided support too and has been equally fantastic with my client.” • “The team supported me and even helped me when I was upset after clearing some of my partners items.” • “Yes, the work the Unpaid Work Team completely helped my client out greatly, it has benefited him and allowed him to achieve a goal he had set for himself. Which is so positive and important.” • “The work undertaken by the Unpaid Work Team is not only giving my client her home back, it is also giving her life and her confidence back.” • “We were able to get a vulnerable client moved and settled into his new home before the Christmas break and without this service we would not have managed this” • “It seems that the team have went over and above to complete this job to this standard and it is very much appreciated to allow the beneficiary to develop to the stage that he is at.” • “I can’t say how much I appreciate all of their help, they are helping me out of a situation that I didn’t know how to get out of or think I would get out of.” • “The work the Unpaid Work Team is currently undertaking is invaluable to my client and to myself as an allocated worker. This property has been deemed as high risk by fire service and therefore was at the point where the risks was exceptional. Through the hard work of xxx (UPW Supervisor) and the Team we are slowly reducing this risk weekly." • “We very much appreciate the last-minute help, it allowed our builder to start our renovation project in our community hub on time." 8) What organisational challenges have there been in completing orders effectively this year, both those with Unpaid Work and those with Supervision Requirements? (Bullet points will suffice. Max 300 words.) Recruitment and retention of staff has continued to be a challenge but as an organisation we have continued to review and develop practice, learning from effective ways of working developed during Covid lockdowns. 9) In this section, please outline how you have worked with other statutory and non- statutory partners to deliver any of the other CPO requirements or similar (Bullet points will suffice. Max 300 words) Page 270 of 348
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7 We work closely with third sector partners to ensure that those subject to a CPO are supported to access local resources and services. We fund a Peer-Co-Ordinator through Health in Mind to ensure that there are peers with justice lived experience able to support those involved in the justice system. The Justice team are co-located with the community- based Substance Misuse and Mental Health services (NHS and local authority) alongside relevant voluntary sector organisations for people in recovery (Health in Mind, MELD and Change Grow Live). This has provided a one stop shop for those experiencing issues related to trauma, mental health and/or offending behaviour to easily access services and reduced barriers to engagement. Sharing of practice knowledge and skills across the services in No 11 has enabled staff to more effectively support clients to achieve outcomes. During the reporting year we continued to work closely with the Substance Use Service to provide treatment pathways for those with an alcohol or illicit substance use issue. This includes triage at the point of the CJSWR to identify individuals who may require an Alcohol or Drug Treatment Requirement as part of a CPO. An outreach Worker from Venture Trust is located within the service once per week. This has enabled us to develop an effective referral pathway and reduced barriers to engagement through developing effective working relationships from the point of referral to completion of programmes through ease of access. The Justice Team continue to have access to consultation and assessment provided by Forensic Psychiatrist and Forensic Psychologists from the Serious Offender Liaison Service (SOLS). This has supported staff in the management of high risk offenders. 10) Outline the main barriers, if any, to accessing community support and wider services (e.g. drug and alcohol services, mental health services). How have these barriers been addressed? There can be a range of barriers to access services, including an individual’s motivation and ability to engage at the point of referral. Through multi-disciplinary working we have managed to reduce a number of these barriers such as making access easier by bringing services together through co-location of services in No 11 and the Spring Service. Transition between child/youth and adult services can be problematic. We are developing a transition pathway for young people subject to a CPO that is imposed between the ages of 18 and 26. This is work that is ongoing and will be informed by research and best practice from other areas. 11) Is there any other relevant information you wish to highlight? For example, this may include: ▪ Areas for improvement and planned next steps ▪ New ways of working and benefits achieved from these. ▪ Examples of work carried out in collaboration with community justice partners and wider community partners, including the third sector, to deliver CPOs (Bullet points will suffice. Max 300 words). Page 271 of 348
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8 As noted above there is work in progress to ensure that we have an effective transition pathway for young people involved in the Justice System. This will include access to diversion and other sentences to reduce involvement, where appropriate, in the formal Justice System and is in line with the Sentencing Guidelines for Young People. The Justice Service are a key partner in the Community Safety and Justice Partnership and work closely with partners to ensure that early and effective interventions are available for those subject to CPO’s or subject to a CJSWR to ensure that the most effective way of managing the person, and the risk they pose is addressed appropriately. The Department of Work and Pensions (DWP) is a key member within the partnership and given the impact of employment and finances within the Justice System are critical in supporting our services. The DWP alongside other partners developed the monthly No 11 drop in which provides clients and staff the opportunity to discuss any matters relevant to the DWPs remit. COMPLETED BY: Julie Jessup DATE: 26th September 2023 CONTACT FOR QUERIES ABOUT THE REPORT Name: Julie Jessup E-mail: Julie.jessup@midlothian.gov.uk Telephone: 07557317112 Page 272 of 348
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1 Integrated Impact Assessment Form Promoting Equality, Human Rights and Sustainability Title of Policy/ Proposal Delivery Community Payback Order Completion Date 12th October 2023 Completed by Julie Jessup Lead officer Julie Jessup Type of Initiative: Policy/Strategy Programme/Plan Ongoing Project Updated Service ✓ Review or existing Function Other Statement of Intent 1. Briefly describe the policy/proposal you are assessing. Page 273 of 348
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2 Set out a clear understanding of the purpose of the policy being developed or reviewed (e.g. objectives, aims) including the context within which it will operate. The Midlothian Justice Service (MJS) provide a service to the Courts whereby we undertake assessments and provide a review of the sentencing options available to the Court; this for men and women who are ordinarily resident in Midlothian who have been convicted of a criminal offence. The information is provided to the Court within a Criminal Justice Social Work Report (CJSWR). The range of sentences include: Custody, Community Payback Order, Drug Treatment and Testing Order, financial penalty, Admonition, Deferred Sentence and a range of disposals under Part VI of the Criminal Procedure (Scotland) Act 1995 (CPSA). The Justice Service is only involved in the supervision or management of some of the sentencing options available to the court, specifically Community Payback Orders (CPO) and custodial sentences where post release supervision is mandated. The Community Payback Order (CPO) replaced community service orders, supervised attendance orders and probation orders on 1 February 2011, and is available to courts for offences committed on or after that date. Sections 227A to 227ZO, and Schedule 13 of the Criminal Procedure (Scotland) Act 1995 (“the 1995 Act”) provide the legislative framework for CPOs. The consent of the individual is needed before the court can impose a CPO unless the order is imposed under section 227M(2) of the 1995 Act for fine default. A CPO can be made with one or more requirements: *Supervision, *Unpaid work, Programme, Compensation, Residence, Mental health, Drug Treatment, Alcohol Treatment, Conduct and Restricted movement. * These are the only 2 requirements that can be standalone. The other requirements must have supervision included also. • There is no minimum age for a CPO (other than the age of criminal responsibility) except where an unpaid work or other activity requirement is made in which case the individual must be aged 16 or above. • Where an individual is under 18 years of age, the court can remit back to the children's hearing system for disposal. The CPO is not however available to the children's hearing system as a disposal. • CPOs can be made for a period of between 6 months and 3 years other than an order consisting solely of an unpaid work or other activity requirement. The latter requirement must be completed within 6 months (3 months for a level 1 requirement) unless the court determines otherwise at the point of sentence. • No requirement, other than an unpaid work or other activity requirement, will be in operation longer than that of any offender supervision requirement. • Where existing provisions require to be extended to allow for completion of the requirement; this can be sought through application to the court. • An offender supervision requirement is mandatory when a CPO is imposed on an individual under 18 years old. Page 274 of 348
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3 • An offender supervision requirement is mandatory when the following requirements are imposed by the court: a programme requirement; a residence requirement; a mental health treatment requirement; a drug treatment requirement; an alcohol treatment requirement; a conduct requirement; a compensation requirement: and a restricted movement requirement. What will change as a result of this policy? There is no change as a result of this policy. An IIA would have been completed when CPOs were introduced in 2011 but I am unable to find a copy. 2. Do I need to undertake a Combined Impact Assessment? High Relevance Yes/no The policy/ proposal has consequences for or affects people Y The policy/proposal has potential to make a significant impact on equality Y The policy/ proposal has the potential to make a significant impact on the economy and the delivery of economic outcomes N The policy/proposal is likely to have a significant environmental impact N Low Relevance The policy/proposal has little relevance to equality N The policy/proposal has negligible impact on the economy Y The policy/proposal has no/ minimal impact on the environment Y If you have identified low relevance please give a brief description of your reasoning here and send it to your Head of Service to record. There is no identified environmental impact from this service. If you have answered yes to high relevance above, please proceed to complete the Integrated Impact Assessment. 3. What information/data/ consultation have you used to inform the policy to date? Evidence Comments: what does the evidence tell you? Page 275 of 348
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4 Data on populations in need Public Protection & Community Justice - Data - Midlothian Health and Social Care Partnership: A three-year profile analysis of offenders in Midlothian identified characteristics which include: • The highest proportion of people involved in offending were resident in Dalkeith/Woodburn. • Over two thirds left school at the minimum leaving age without further formal education. • 38% had financial problems. • A quarter had accommodation problems. • 57% had a history of alcohol misuse. 48% had a history of drug problems. Scottish data shows a strong association between mental health issues and offending. Two in three women prisoners suffer from depression, and just under half of female prisoners have attempted suicide. Particular concerns are raised around the proportion of prisoners struggling to form positive attachments; 46% of prisoners reported they rarely/never ‘felt interested in other people’, 48% reported they rarely/never ‘felt loved’ and 49% reported they rarely/never ‘felt close to other people’. It is estimated that the prevalence of learning disabilities among offender populations is much higher than the general population with around 20% to 30% of offenders within the criminal justice system affected by a learning disability. There is a high correlation between being in prison and income inequality, social mobility, teenage births, and high levels of obesity and smoking. Domestic violence is also associated with offending behaviour, nationally 43% of young offenders report witnessing violence between their parents or guardians as a child. Scottish data also shows a strong relationship between gender and Community Justice. Males accounted for 82% of all people convicted in 2018/19 but represented a higher proportion of all custodial sentences (91%) totalling 11,092 men. By contrast Page 276 of 348
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5 women accounted for 18% of people convicted compared to a lower proportion for custodial sentences (9% of custodial sentences). Males also have higher reconviction rates and a higher average number of reconvictions per offender than females Data on service uptake/access In 22/23 there were 261 full Criminal Justice Social Work Reports (CJSWR) reports completed for courts – (this represented 251 individuals: 219 males and 42 females). Within these reports a CPO was the preferred outcome recommended for 113 individuals: 94 males and 19 females). A total of 137 CPOs were subsequently imposed by the court: 109 males and 28 females. Data on quality/outcomes Although a presentation of problematic behaviour is not an indicator that someone will become involved in offending, if you have been involved in the Justice system you are more likely to be negatively impacted by mental health issues. Scottish prison population survey (17th Prison Survey 2017 and 2019): • 50% of prisoners struggled to feel interested in other people. 53% identified issues feeling close to other people. 41% identified drug use as a problem for them in the community and 45% stated that they had been under the influence of substances when they committed their offence. • Research on females in custody Public Health England found that 65% of women in prison suffer from depression compared to 37% of men. Just under half (46%) of female prisoners have attempted suicide at some point. Research from the Female Offender Strategy (Ministry of Justice Female Offender Strategy June 2018): • 60% of female offenders have experienced domestic abuse and the complexity of female criminality is often embedded in family disputes, trauma and mental health; exacerbating their Page 277 of 348
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6 ability to desist from further offending or to achieve positive mental health and wellbeing. Evaluation of Community Payback Orders, Criminal Justice Social Work Reports and the Presumption Against Short Sentences - gov.scot (www.gov.scot) Evaluation completed in 2013-14 by Scotcen Social Research: “Research has consistently shown that community penalties are more effective than short prison sentences in reducing offending, and that they can play an important role in addressing some of the individual and social harms associated with crime” (ref Reducing Reoffending: Review of Selected Countries. SCCJR Research Report No: 04/2012. Armstrong, S. and McNeill, F. (2012). Within the ‘Vision for Justice in Scotland 2022’ Scottish Government noted that “Community interventions are more effective than short prison sentences at addressing offending behaviour and breaking the cycle of reoffending. Prison can by its very nature disrupt factors that can help prevent offending, including family relationships, housing, employment and access to healthcare and support”. One of the measures of effectiveness of sentences is the reconviction data published by Scottish Government. In 2020 it was noted that the reconviction rate in Scotland had fallen to a 21 year low. The most recent available data (17 – 18 cohort showed that: • Officials statistics for the 2017-18 offender cohort show the percentage of offenders who are reconvicted in a year was 26.3% – which is a one percentage point decrease from 27.3% in 2016- 17. • The average number of reconvictions – a measure of how often offenders are reconvicted – also fell over the same period from 0.48 to 0.46, a reduction of 4%. • Offenders who committed a crime of dishonesty had the highest reconviction rate, compared to offenders that committed another type of crime. Page 278 of 348
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7 Offenders who committed a sexual crime had the lowest reconviction rate. • The statistics also show that offenders given a short custodial sentence of one year or less are reconvicted nearly twice as often as those given a Community Payback Order (CPO): The reconviction rate for CPOs, the most commonly used community sentence, was 29.1% in 2017- 18, which was a decrease of 2.2 percentage points from 31.3% 2016-17. The average number of reconvictions per offender for CPOs was 0.51 in 2017-18 which a 9% decrease from the figure of 0.56 in 2016-17. The available research tells us that those who successfully complete a CPO are more likely to desist from further offending behaviour. The successful completion rate is worked out by adding the number of successfully completed orders (not revoked after breach action) and the number of Early Discharges (on good progress) and taking away the number of people who transferred out of area and not knowns and dividing this figure by the total number of orders imposed. There are a number of factors that can impact on whether or not an order is successfully completed. Within Midlothian the number of successful completion of a CPO has been consistent with, or higher than that national average: 2016/17: 82% (69%) 2017/18: 73% (69%) 2018/19: 75% (68%) 2019/20: 71% (69%) 2021/22: 74% (74%) Research/literature evidence Community interventions are more effective than short prison sentences at addressing offending behaviour and breaking the cycle of reoffending. Prison can by its very nature disrupt factors that can help prevent offending, including family relationships, housing, employment and access to healthcare and support. • Reconviction Statistics 2017-18 Scottish Government • ‘Vision for Justice in Scotland 2022’ Scottish Government • Armstrong, S. and McNeill, F (2012).Reducing Reoffending: Review of Selected Page 279 of 348
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8 Countries. SCCJR Research Report No: 04/2012. Armstrong, S. and McNeill, F. (2012). • Scottish Government (2019) Community Payback Order: Practice Guidance • Scottish Government (2010) National Outcome and Standards for Justice Social Work Services Service user experience information Feedback from service users, and beneficiaries. Feedback is sought at the start and the end of the CPO and during the course of an order. This feedback was gathered for the CPO Annual Reports 2021-22 and 2022-23: “They responded extremely promptly to my request to help a service user. The team communicated well and competed the house move very quickly.” (Learning Disability Team – Social Worker) “They were very helpful and friendly” (direct beneficiary) “The team supported a care experienced young person by collecting and delivering 2 sofas to her new tenancy. Good service provided and this has helped the young person to continue to settle into her new home.” (Children’s Services 12plus Team) My client is a looked after young person by the CF department. Without the support of the unpaid work team he would not have been able to secure this move to his own home. Great work by all. I appreciate the time and support given to move my young person.” (Children’s Services 12plus Team) “The Community Payback Team has worked with us for a few years now and continues to provide help and support to our organisation and our community. They provide a team of able bodied people who can work with our staff and volunteers to move food donations, build and maintain structures within the garden and improve the facilities we provide. Some of the payback participants have come to volunteer and even work with us after their orders have completed and so this has further strengthened our organisation and the services we provide to our community. This is a valuable and fruitful partnership for both parties, which greatly contributes to our community wellbeing. We Page 280 of 348
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9 aim to continue and develop this partnership.” (Community Trust Manager) Looking at my accountability, I felt different after being at Court and hearing what the victims said. Hearing the victim’s account has made me see things from a different perspective and I need to keep doing this” “I don’t want to be seen as an angry person. I want to be better and not have to put my children in a situation that would arise if I lost my temper, I would end up in custody”. “stealing had become a bit of a habit and wanted to change this, coming in and talking to Rachel about my finances and getting into trouble is helping me”. “I was really nervous coming to Stride the first time, well actually I didn’t even go! I thought then I would have a mark against my name but the team were great. They meet me on my own and made me feel comfortable to come along to group. I’m really glad I done it cause it was great meeting new people and sharing some stuff that could help us all get a better life. I wouldn’t have got that if I hadn’t went to Stride” “gives me structure and routine and I meet new people” “helps me understand emotions “ “I have learned skills to keep calm and walk away” A service user identified positive changes he had made during his order, listing the following as having a direct impact on his use of time, mental health and stability: “Completing stride; referred to Cyrenians Activities Group. At the end of his completion questionnaire he noted “really pleased to be finishing order – proud” Consultation and involvement findings See above Good practice guidelines Scottish Government (2010) National Outcome and Standards for Justice Social Work Services Scottish Government (2019) Community Payback Order: Practice Guidance Scottish Government (2010) National Outcome and Standards for Justice Social Work Services Page 281 of 348
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10 Other (please specify) Is any further information required? How will you gather this? No. 4. How does the policy meet the different needs of and impact on groups in the community? Equality Groups Comments – positive/ negative impact Older people, people in the middle years, No differential impact Young people and children Positive impact – will be able to access services, where appropriate by risk assessment. This will enable more positive outcomes to be achieved. Women, men and transgender people (includes issues relating to pregnancy and maternity) Positive impact. As noted above there will be an increased opportunity for support to access services. Disabled people (included physical disability; learning disability; sensory Impairment; long term medical conditions; mental health problem) No differential impact. We seek to ensure that all clients have access to appropriate services/resources to avoid exclusion. Minority ethnic people (includes Gypsy/Travellers migrant workers non-English Overall no differential impact. There may be a more positive impact for individuals from the travelling community as they are more likely to engage in a pre-sentence intervention as would be regarded as voluntary and are therefore less likely to be further up-tariffed by imposition of a community payback order. Refugees and asylum seekers No differential impact. We seek to ensure that all clients for whom English is not their first language that translation services are Page 282 of 348
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11 available to avoid exclusion. People with different religions or beliefs (included people with no religion or belief. No differential impact Lesbian; gay bisexual and heterosexual people No differential impact People who are unmarried; married or in a civil partnership No differential impact Those vulnerable to falling into poverty Positive impact. Support and assistance would be provided to enable improved problem solving skills. Support and assistance with accessing benefits and referrals to relevant support services. Unemployed Positive impact due to referral to appropriate support agency and assistance with developing employment and training, qualifications and upskilling through unpaid work People on Benefits Positive impact due to potential for support and assistance with accessing benefits and referrals to relevant support services. Single Parents and vulnerable families Positive impact as noted above. Pensioners Positive impact due to potential for early intervention and support. This could include assistance with independent living and benefits. Looked after Children Positive impact – potential for early intervention and signposting to relevant support services and advocacy as a young person with experience of being looked after. This would include support to achieve a positive destination. Those leaving care settings ((including children and young Positive impact – as noted above. Page 283 of 348
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12 people and those with illness) Homeless People Positive impact. Intervention and referral to support agencies including assistance with applications. Carers (including young carers) No differential impact Those involved in the criminal justice system This service is only for those going through the sentencing process at Court. Those living in the most deprived communities (bottom 20% SIMD areas) Positive impact – as noted for the groups listed above. People misusing services Positive impact – intervention and signposting to appropriate services. Work can be undertaken to develop coping strategies and therefore reduce misuse of services. People with low literacy/numeracy Positive impact - intervention and referral to appropriate support agency and assistance with developing employment and training Others e.g. veterans, students Positive impact due to potential for early intervention and referral to appropriate support agency and assistance with developing employment and training Geographical Communities Rural/ semi rural Communities No differential impact Urban Communities No differential impact Costal Communities Not applicable 5. Are there any other factors which will affect the way this policy impacts on the community or staff groups? No. Page 284 of 348
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13 6. Is any part of this policy/ service to be carried out wholly or partly by contractors? If yes, how have you included equality and human rights considerations into the contract? Partially. Support will be provided by third sector partner agencies in respect of some of the requirements and/or based on assessment of need. These could include: Change Grow Live, Health in Mind, Cyrenians and Venture Trust Scotland. Service Level Agreements are already in place for them to work with clients in the Criminal Justice System. 7. Have you considered how you will communicate information about this policy or policy change to those affected e.g. to those with hearing loss, speech impairment or English as a second language? Yes. We already work with Alpha Translation Services and Royal National Institute of Blind People when necessary. Any other communication request can be made by emailing equalities@midlothian.gov.uk or by telephoning 0131 271 3658. 8. Please consider how your policy will impact on each of the following? Objectives Equality and Human Rights Comments Promotes / advances equality of opportunity e.g. improves access to and quality of services, status Positive impact for the target group due to statutory intervention and referral to appropriate support agency and assistance with developing employment and training and access to housing Promotes good relations within and between people with protected characteristics and tackles harassment No differential impact Promotes participation, inclusion, dignity and self- control over decisions Positive impact. The role of Justice Services is to promote inclusion. Builds family support networks, resilience and community capacity Positive impact. The role of Justice Services is to promote inclusion and resilience. Page 285 of 348
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14 Reduces crime and fear of crime This is a more difficult one to quantify as fear of crime can be a personal experience. There should however be a positive impact, on reduction of crime, through the provision of support to effectively impact on reconviction rates. Promotes healthier lifestyles including Diet and nutrition Sexual Heath Substance Misuse Exercise and physical activity Life Skills Positive impact. We work closely with the Health Inequalities Team to ensure that clients have access to health services. The Justice Service is co-located with Substance Misuse Service, Joint Mental Health Team and Community Mental Health services to increase greater integration of services and ensure ease of access for clients/patients. Environmental Reduce greenhouse gas (GHG) emissions in Midlothian (including carbon management) Not applicable Plan for future climate change Not applicable Pollution: air/ water/ soil/ noise Not applicable Protect coastal and inland waters Not applicable Enhance biodiversity Not applicable Public Safety: Minimise waste generation/ infection control/ accidental injury /fire risk Not applicable Reduce need to travel / promote sustainable forms or transport Not applicable Improves the physical environment e.g. housing quality, public and green space Not applicable Economic Maximises income and /or reduces income inequality Positive impact. By supporting clients to access services, including employability and training providers Page 286 of 348
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15 Helps young people into positive destinations Positive impact. Young people are a priority target Supports local business Not applicable Helps people to access jobs (both paid and unpaid) Positive impact. The role of justice social work is to have a positive impact on a person’s risk of re-offending. One aspect of achieving this is through social inclusion and supporting a person to a positive destination. This then makes the person more able to be a fully functioning member of society including being able to take part in the labour market as appropriate. Improving literacy and numeracy Positive impact. There are lower levels of literacy among those who have a pattern of offending behaviour and those who have had disruptions to formal education. Individuals will be supported to achieve their potential and to access to support from lifelong learning and development. Improves working conditions, including equal pay Not applicable Improves local employment opportunities Not applicable 9. Is the policy a qualifying Policy, Programme or Strategy as defined by The Environmental Impact Assessment (Scotland) Act 2005? No 10. Action Plan Identified negative impact Mitigating circumstances Mitigating actions Timeline Responsible person None Page 287 of 348
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16 11. Sign off by Chief Officer Signature Name Morag Barrow Date 25/10/23 Page 288 of 348
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Midlothian Integration Joint Board Thursday, 21st December 2023, 14:00-16:00 East Lothian and Midlothian Public Protection Committee Annual Report 2022-23 Executive summary The East Lothian and Midlothian Public Protection Committee (EMPPC) is the local strategic partnership responsible for the overview of policy and practice in relation to Adult Support and Protection, Child Protection, MAPPA and Violence Against Women and Girls. The annual report highlights all the elements of its areas of business into one report on an annual basis. This provides an opportunity to give a high-level overview of all areas of the business and illustrate their connectivity and intersectionality within the context of a lifespan approach. Members are asked to: • Note the contents of the report. # Item number: 5.13 Page 289 of 348
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Midlothian Integration Joint Board Midlothian Integration Joint Board East Lothian and Midlothian Public Protection Committee Annual Report 2022-23 1 Purpose 1.1 The purpose of this report is to introduce the East Lothian and Midlothian Committee Annual Report. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the report. 3 Background and main report 3.1 The East Lothian and Midlothian Public Protection Committee (EMPPC) is the local strategic partnership responsible for the overview of policy and practice in relation to Adult Support and Protection, Child Protection, MAPPA and Violence Against Women and Girls. The primary aim of the Committee is to provide leadership and strategic oversight of Public Protection activity and performance across East Lothian and Midlothian. It discharges its functions through four sub-groups. 3.2 EMPPC completes an annual report to highlight all the elements of its areas of business into one report on an annual basis. This provides an opportunity to give a high-level overview of all areas of the business and illustrate their connectivity and intersectionality within the context of a lifespan approach. 3.3 The governance of the EMPPC annual report is provided through the Critical Services Oversight Group (CSOG). This report was approved at the CSOG meeting on 8th August 2023. 4 Policy Implications 4.1 There are no direct policy implications arising from this report. 5 Directions 5.1 This report is not related to the Directions of the IJB. 6 Equalities Implications 6.1 This report has no implications for groups of people with protected characteristics Page 290 of 348
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Midlothian Integration Joint Board 6.2 This report does not result in the requirement to revise or develop a new strategy, policy, plan, provision, practice, or activity 7 Resource Implications 7.1 There are no direct implications for resources in relation to this report. 8 Risk 8.1 N/A 9 Involving people 9.1 Consultation and collaboration with key public protection agencies support the delivery of key policy and practice. Four EMPPC sub-groups operate across East and Midlothian, with membership from chief stakeholders. 10 Background Papers 10.1 N/A AUTHOR’S NAME Kirsty MacDiarmid DESIGNATION Public Protection Manager, East Lothian and Midlothian Public Protection Office CONTACT INFO kmacdiarmid@eastlothian.gov.uk DATE 12-10-23 Appendices: Appendix One: East Lothian and Midlothian Committee Annual Report Page 291 of 348
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1 Contents Foreword from the Chair ........................................................................................................... 2 Introduction ............................................................................................................................... 4 Our Strategic Structure for Public Protection in East Lothian and Midlothian ......................... 4 Reporting Cycle of EMPPC ......................................................................................................... 5 East Lothian and Midlothian Public Protection Office ............................................................... 6 EMPPC Vision ............................................................................................................................. 6 EMPPC Priorities ........................................................................................................................ 7 Supporting Strategic Leadership ................................................................................................ 9 Adult Support and Protection (ASP) ........................................................................................ 10 Child Protection ....................................................................................................................... 21 Violence Against Women and Girls (VAWG) ........................................................................... 33 MAPPA ..................................................................................................................................... 45 Learning and Development ...................................................................................................... 46 EMPPC Newsletter ................................................................................................................... 50 Looking forward ....................................................................................................................... 51 Appendix 1 Page 294 of 348
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2 Foreword from the Chair As Chair of East Lothian and Midlothian Public Protection Committee (EMPPC), I am pleased to present our Annual Report (2022-2023) that marks the work of our multi-agency public protection partnership. As the first independent Chair, having taken up position in April 2023 my first duty in this report is to thank the outgoing Chair, Anne Neilson who worked tirelessly as Director of public protection in NHS and since 2014 as Chair for the EMPPC until her recent retirement. As I settle in to my role, I have been reflecting on the incredible work carried out by all of the partnership staff. The scope and scale of public protection duties carried out under relentless operational pressures. The safeguarding of well-being, safety and security of the vulnerable and general public through various measures and initiatives encompassing a wide range of activities and sectors. We work with an ever-expanding population, increasing demands, evolving threats and the need for continuous adaptation and innovation. We face the challenge of balancing proactive prevention measures with reactive response capabilities. We need to allocate resources effectively, collaborate with other agencies and stakeholders whilst intelligence gathering, risk assessing, training and capacity building, public awareness campaigns, community engagement and the development of policies and regulation. In the past year we have continued as a partnership to recover from the demands of the COVID pandemic. We have taken the opportunity to look at ourselves and consider our true role and have refreshed our EMPPC Vision Statement. We look forward with horizon scanning, looking to better learn from the lived experiences of both the survivor voices; those we serve and protect as well as the experience and learned perspective of our staff to bring about a stronger overall product. It has been a year with new Child and Adult Protection National Guidance, both of which required a great depth of thought and discussion to ensure we train and support our people giving them the knowledge and the tools to work effectively to implement best practice with governance structures in place. We have had to develop and diversify to support families displaced from Ukraine, and also look to support people through the added difficulties of the cost-of-living crisis and the effects that this has on public protection. We have looked at new ways to better communicate both with the public through social media and local and National campaigns, and with our staff through the development of our EMPPC Newsletter which has continued to receive great feedback as it further evolves. We are sad to see some of our key people moving on to pastures new but happy and excited to see them take on new challenges. Iain Gorman, Head of Operations in the East Lothian Health and Social Care Partnership moving on, Judith Tait, Chief Social Work Officer and Page 295 of 348
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3 Chief Operating Officer Children’s Services in East Lothian, also moving on, and Veronica Campanile, our Violence Against Women and Girls Coordinator retiring. We thank them for their great work and efforts over the past years. I would like to thank all the members of the Committee and associated sub groups for their continuing support and commitment going forward and express a huge thanks to all staff across all agencies who work so incredibly hard and professionally to protect the people in our communities. I look forward to continuing our work together this coming year. Keith Mackay Chair, East Lothian and Midlothian Public Protection Committee Page 296 of 348
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4 Introduction An annual report of the work of East Lothian and Midlothian Public Protection Committee has been produced since its inception in 2014. Although we are required to prepare an annual report for only one of our areas of business1 we believe that it is important to bring together all the elements of our areas of activity into one report on an annual basis. This provides the opportunity to give a high level overview of all the areas of our business, and illustrate their connectivity and intersectionality within the context of a lifespan approach. Our Strategic Structure for Public Protection in East Lothian and Midlothian Through the Critical Services Oversight Group (CSOG), the Chief Officers of our core partners (Council, NHS and Police) provide strategic leadership, scrutiny, governance and direction to EMPPC. CSOG is co-chaired by Monica Patterson, Chief Executive of East Lothian Council and Grace Vickers, Chief Executive of Midlothian Council. The East Lothian and Midlothian Public Protection Committee (EMPPC) is the local strategic partnership responsible for the overview of policy and practice in relation to ASP, Child Protection, MAPPA and Violence Against Women and Girls. The primary aim of the Committee is to provide leadership and strategic oversight of Public Protection activity and performance across East Lothian and Midlothian. It discharges its functions through four sub-groups. Since the inception of EMPPC in 2014 the Chair was Anne Neilson, Director of Public Protection, NHS Lothian, until she stepped down from the role in early 2023. An independent Chair was recruited in the early part of 2023, with Keith Mackay taking up the appointment from April 2023. The Learning and Practice Development Sub-group (L&PD Sub-group) oversees the development and delivery of the Learning and Development strategy, and our multi-agency training programme. Our Chair for the year was Fiona Stratton, Chief Nurse, Midlothian Health and Social Care Partnership. The East Lothian and Midlothian MAPPA Group (EMMG) ensures that the statutory responsibilities placed on local partner agencies for the assessment and management of risk posed by offenders subject to MAPPA are discharged effectively. The Chair was Judith Tait, Chief Social Work Officer/Chief Operating Officer, Children's Services, East Lothian Council, until she departed from her post in March 2023. The Chair for the coming year will be Lindsey Byrne, Chief Social Work Officer/Head of Children's Services, East Lothian Council. The Performance and Quality Improvement Sub-group (P&QI Sub-group) is responsible for the oversight and governance of the performance framework and improvement plan. The 1 Annual reporting on the work of Child Protection Committees is one of their core functions (Protecting Children and Young People: Child Protection Committee and Chief Officer Responsibilities). There is currently no requirement to provide an annual report on the work of a Violence Against Women and Girls Partnership. Under the Adult Support and Protection (Scotland) Act 2007, a biennial report is required on the work of the Adult Protection Committee (Section 46). Page 297 of 348
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5 Chair is Joan Tranent, Chief Social Work Officer/Chief Operating Officer Children's Services, Communities and Partnerships, Midlothian Council. The Violence Against Women and Girls Delivery Group (VAWG Delivery Group) works to support the delivery of Equally Safe: Scotland’s strategy for preventing and eradicating violence against women and girls in line with the local context and priorities. The Chair was Keith Mackay, Detective Chief Inspector, J Division, Police Scotland, until his departure from his role in March 2023. Steve Wood, Detective Chief Inspector, J Division, Police Scotland has taken over as Chair. The Learning Review Sub-group (LR Sub-group) will support the oversight of the progress of Learning Reviews, the development and progress of action plans, and dissemination of learning. The Chair is Keith Mackay, Independent Chair of EMPPC. Reporting Cycle of EMPPC Our Committee runs based on quarterly cycles, as shown in the attached diagram, and the reporting therefore covers the quarters detailed below. The reporting of data and performance follows the academic quarters for Child Protection. The reporting of all our other data (ASP, Violence Against Women and Girls, Drugs and Alcohol, MAPPA and Learning and Development) follows financial quarters. All our data reports are reviewed and considered by our P&QI Sub-group, and thereafter are reported to EMPPC. In the coming year, our new Learning Review Sub-group will meet in the same month as EMPPC and report directly to CSOG. Financial Quarter 1 (Apr – Jun) + Academic Quarter 3 (Feb – Apr) EMPPC Sub-groups August EMPPC September Financial Quarter 3 (Oct - Dec) + Academic Quarter 1 (Aug – Oct) CSOG October Financial Quarter 2 (Jul - Sept) + Academic Quarter 4 (May – Jul) EMPPC Sub-groups November EMPPC December CSOG January EMPPC Sub-groups February EMPPC March CSOG April Financial Quarter 4 (Jan - Mar) + Academic Quarter 2 (Nov – Jan) EMPPC Sub-groups May EMPPC June CSOG July Page 298 of 348
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6 East Lothian and Midlothian Public Protection Office The East Lothian and Midlothian Public Protection Office (EMPPO) supports the delivery of the operational and strategic objectives and priorities of the EMPPC and its Sub-groups. The EMPPO is jointly funded by East Lothian and Midlothian Councils, Police Scotland and NHS (Health and Social Care Partnerships in East Lothian and Midlothian). Its operational base is the Brunton Hall, Musselburgh. Staff include Senior Business Support Administrator, Business Support Assistant (0.5), Lead Officer for ASP, Lead Officer for Child Protection, Violence Against Women and Girls Co- ordinator, Marac Co-ordinator and Public Protection Manager. The staff within the office are responsible for: • Working with multi agency partners to promote effective inter-agency policy and practice, by providing consultation, advice and guidance; • Supporting the implementation of national policies, and developing local procedures and guidance; • Maintaining an independent overview of inter-agency activity in ASP, Child Protection and Violence Against Women and Girls; • The co-ordination, delivery and evaluation of multi-agency training, learning and development in the different areas of Public Protection; • Supporting the collation and facilitating review of data and performance information and contributing to the identification and development of improvement actions; • Co-ordinating the scheduling of meetings of the EMPPC and associated groups, and providing secretariat services to support their smooth functioning; • Developing and delivering key communications and messages about Public Protection; • Supporting and co-ordinating the process of carrying out learning reviews and supporting the embedding of learning into practice, policy and guidance; and • The operational delivery of Marac. EMPPC Vision At one of our Committee meetings in the year we took time to refresh our vision and articulate our core values, as follows: • Everyone has a right to be safe and protected from harm and abuse. We will protect our babies, children, young people and adults in East Lothian and Midlothian by working together and upholding our values. • Our core values of respect, integrity and commitment underpin our work in supporting and protecting all people who may be at risk of harm in our communities. Page 299 of 348
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7 Respect • For anyone who needs protection and support in all that we do • The contribution that the representative brings to the partnership on behalf of their agency/organisation • The fact that the partners have different responsibilities and constraints within their own organisation • The opinions and ideas of each representative Integrity • Being honest and trustworthy in our partnership working • Having strong moral principles and doing ‘the right thing’ • Following through on agreed commitments and being accountable and responsible for the actions • Encourage and respect challenge in our partnership working Commitment • To improvement in our work with anyone who needs protection and support • Being prepared for and pro-active in the work of EMPPC • Engaging and participating to drive forward the work of EMPPC • Listening to and acting on the views of the people we work with EMPPC Priorities Our business plan was presented to EMPPC in June 2022, with 38 actions under the following five priorities/high level aims: 1. We will continue to strengthen our leadership arrangements in Public Protection 2. We will provide and support the implementation of multi-agency procedures and guidance for staff working in Public Protection 3. We will continue to develop our performance framework and approach to quality improvement 4. We will promote a learning culture by providing staff with multi-agency learning and development opportunities in Public Protection 5. We will raise awareness of Public Protection through communications and engagement with staff and communities The narrative that follows in this report provides an overview of the progress of our actions and improvement activities to support effective multi-agency partnership working in Public Protection in East Lothian and Midlothian. EMPPC was updated by members about the challenging context of the strategic and operational delivery of services within Public Protection. Challenges in recruiting operational staff to services is not just a local issue in East Lothian and Midlothian, but a national one, and there were continued staff absences due to the continuing impact of the COVID pandemic. The budgetary pressures faced by partner agencies and the growing populations within East Lothian and Midlothian make for a challenging landscape when delivering services at all levels, but particularly around prevention and early intervention. In 2022, East Lothian had an estimated population of 108,972, the 21st highest of the 32 Local Authority areas in Scotland. The population is projected to increase by 9.7% (2018 based) to 116,006 Page 300 of 348
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8 in 2032. This is the second highest increase in Scotland. In 2022, Midlothian had an estimated population of 96,473, the 23rd highest of the 32 Local Authority areas in Scotland. The population is projected to increase by 18.8% (2018 based) to 108,525 in 2032. This is the highest increase in Scotland. An increase in vulnerability for children, young people, adults and families is inevitably compounded by the current cost of living crisis. Notwithstanding this context, EMPPC heard how services continued to prioritise Adult Support and Protection and Child Protection service delivery to support and protect the most vulnerable people in our communities. The operating context and impact on progress of actions within our Business Plan were reported to CSOG for the oversight and assurance. Page 301 of 348
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9 Supporting Strategic Leadership To progress some of the activity within the Joint Strategic Needs Assessment for Public Protection (2021), our CSOG began a programme of development to review its existing structure and function, and identify areas for improvement. CSOG have welcomed the support of our EMPPC Care Inspectorate link inspectors who facilitated two of four sessions in the year, using the national Chief Officers Public Protection Induction Resource materials as a framework. This work will continue into the coming year, with improvement actions taken forward through our Business Plan. Page 302 of 348
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10 Adult Support and Protection (ASP) Data and Performance Information – East Lothian The three most common referral sources were: 2022-23 Police 46.00% NHS 16.90% Social Work 8.70% 2021-22 Police 24.90% Other orgs 16.50% NHS 14.90% 2020-21 Police 33.30% Others 15.30% Other orgs 18.70% 2019-20 Police 30.20% Other orgs 18.70% NHS 12.30% 2018-90 Police 29.30% Others 20.80% Other orgs 13.50% East Lothian saw an increase of 173 referrals in the year, which is a 26.9% increase from the previous year. Over two years, this is a referral increase of 60%. During the year East Lothian changed their counting rules on referrals to include a ‘further referral’ in an open ASP case (this was in line with what Midlothian was already doing). This only partially reflects an increase in referrals. It may be that we are seeing a natural and expected post-pandemic increase in ASP referrals, as services and supports have become more accessible, with adults at risk of harm being more visible to referring agencies since restrictions eased. There was an increase of 247 (58.8%) Duty to Inquires in the year. The highest overall ASP activity was in Quarter 3 (Oct - Dec). We saw a substantial increase in referrals from Police (by 216) and NHS (by 48), with Police remaining the most frequent referrer of ASP referrals in East Lothian. 493 530 791 778 562 511 643 816 226 343 471 280 235 357 420 667 69 148 112 86 47 51 80 115 0 100 200 300 400 500 600 700 800 900 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23 ASP by year - East Lothian ASP referrals ASP Duty to Inquires ASP Investigations Page 303 of 348
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11 The conversion rate from referral to Duty to Inquire increased substantially over the past year. We should exercise caution in drawing conclusions about the dip to the lowest points of conversion from referral to DTI between 2018/19 and 2019/20 due to the way in which referrals were counted. The increase in conversion from referral to DTI in the past year is considered to be due to strengthened managerial oversight, introducing increased consistency in approach. Due to changes in the Social Work recording system mid-year, we are not able to report on the 816 referral outcomes. Outcomes reported are based on 880 referrals, of which 64.1% had some form of further action (either ASP or non-ASP action). ASP Investigations • There were 116 investigations in the year, an increase of 36 • 31 of investigations were in the age group 40 – 64, and 28 in the age group over 80 • The most common principal type of harm investigated was identified as ‘other’ (23 cases, which would include a range of issues), followed by financial harm (22) and physical harm (22). We have identified a potential under-identification of self-neglect as a principal type of harm and are currently auditing a sample of cases from Quarter 4 (refer to the Quarterly report for this). Last year the most common type of harm was neglect (which included self-neglect) • The location of principal harm was own home in 72 cases, 15 in a public place and 8 in a care home • There were investigations for 44 males and 71 females (based on 115 investigations) • 31% of investigations led on to further ASP work (based on 115 investigations) ASP Case Conferences • There were 80 case conferences in the year, 36 initial case conferences and 44 reviews. This was 29 more case conferences than in the previous year (26 initial case conferences and 25 reviews) 45.84 64.72 59.54 35.99 41.81 69.86 65.32 81.74 30.53 43.15 23.78 30.71 20.00 14.29 19.05 17.24 0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00 80.00 90.00 100.00 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23 Conversion rates conversion from referral to DTI conversion from DTI to Investigation Page 304 of 348
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12 Data and Performance Information – Midlothian The three most common referral sources were: 2022-23 NHS 23.79% Police 22.28% Other orgs 14.10% 2021-22 NHS 21.4% Other orgs 19.0% Police 18.4% 2020-21 Police 29.4% Other orgs 19.0% Family 10.8% 2019-20 Police 21.8% Other orgs 20.7% Council 13.0% 2018-19 Police 30.6% Other orgs 15.5% Others 12.3% Midlothian saw an increase of 225 referrals in the year, which is a 37.8% increase from the previous year. In the two years since the beginning of the pandemic lockdown, this is a referral increase of over 100%. There was an increase of 90 (27.7%) DTIs. This had implications for resource management and the need to strengthen the Council Officer duty rota arrangements out with the dedicated ASP team. We will progress plans to increase the support/training and learning opportunities for all Council Officers and their line managers in the coming year to support ASP work. The highest overall ASP activity was in Quarter 4 (Jan-Mar). We saw an increase in referrals from Police (by 83) and NHS (by 77) with NHS being the most frequent referrer for the second year in a row. 452 501 681 690 536 468 453 674 929 276 305 223 189 177 196 325 415 94 129 82 87 65 46 56 106 119 0 100 200 300 400 500 600 700 800 900 1000 2014/15 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23 ASP by year - Midlothian Referrals DTIs Investigations Page 305 of 348
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13 The conversion rate from referral to DTI has sat below 50% for the seventh year in a row. A significant proportion of referrals are screened out at the initial stage without progressing to a DTI, however, when we look at the outcomes recorded on referrals, almost all referrals have some form of action, and are referred to other teams/services within the HSCP. It has been agreed that in the coming year we will routinely sample a portion of referrals per quarter that did not progress to a DTI to understand more about what this data is telling us – including about thresholds for decision making, quality of referral information, repeat referrals. There were 929 referrals for 742 adults in the year (we do not have previous year comparative data for this), with a small number of adults being referred on multiple occasions. ASP Investigations • There were 119 investigations in the year, an increase of 13 • 31 of investigations were in the age group 40 – 64, and 19 in the age group over 80 • Financial harm was the most common principal type of harm investigated (38 cases); this has been the most common type of harm in six of the last seven years. ‘Other’ types of harm made up 26 of investigations and neglect 18 • The location of principal harm was own home in 80 cases and 15 in a care home – it was not known in 17 cases • There were investigations for 39 males and 80 females • 27% of investigations led on to further ASP work, handled primarily by the dedicated ASP team ASP Case Conferences • There were 42 case conferences in the year, 20 initial case conferences and 22 reviews. This were 11 more case conferences than in the previous year (22 initial case conferences and nine reviews) 55.09 44.79 32.32 35.26 37.82 43.27 48.22 44.6746.74 26.89 39.01 34.39 25.99 28.57 32.62 28.67 0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00 80.00 90.00 100.00 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23 Conversion rates conversion referral to DTI conversion DTI to Investigation Page 306 of 348
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14 Preparation for national minimum ASP dataset To prepare for the introduction of the national minimum dataset for ASP, key personnel from East Lothian and Midlothian attended and engaged with the national briefings provided by IRISS and the Scottish Government. A presentation providing an overview of the new dataset was delivered to our P&QI Sub-group and EMPPC. Our ASP Lead Officer and Public Protection Manager met with the local leads in East Lothian and Midlothian to review the implications for practice and changes required to data recording, to support the introduction of the new minimum dataset. Due to the extent of system changes required in both areas, and an ASP inspection in East Lothian, we agreed to implement the new dataset for both areas from Quarter 2, 2023/24. Supporting Practice in ASP Analytical Risk Management in ASP It had become apparent through audit work and from discussion with operational managers that there was a need to improve the analysis and articulation of assessment of risk in ASP. We developed local guidance, called Analytical Risk Management in ASP, which included a framework to support staff to identify and articulate the interaction between types of harm, imminence, likelihood and severity of impact (known as the ‘TILS’ framework). In East Lothian, changes were made to the Social Work recording system to incorporate this framework into the ASP templates, and thereby support practice improvement. Similar changes are being progressed in Midlothian. To raise awareness, we have incorporated the approach into our Council Officer training/Forums, included an article in our newsletter and the ASP Lead Officer delivered presentations at the P&QI Sub-group and EMPPC. We will further strengthen this over the coming year through the Council Officer Forums and in the implementation of our revised ASP procedures. Council Officer Forums Our ASP Lead Officer supports and leads the Council Officer Forum in each area. It provides protected time on a monthly basis to reflect on ASP practice and the opportunity for inputs on key areas of practice relating to ASP, including: • ASP and professional curiosity, SMART safety planning, Chronologies, Assessing capacity; • Giving the opportunity to reflect on the transfer of learning from topics covered in the Forum into practice through case examples; and • Updates on local and national developments. Attendance at the Council Officer Forum is currently on a voluntary basis, and we have found it has attracted a consistent group of the same Council Officers. During the coming year, we will seek to strengthen the engagement in this Forum to ensure that all Council Officers are motivated and supported to access the learning and development opportunities and peer support it offers. Page 307 of 348
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15 Pan Lothian Chronology Group The key messages from the Pan Lothian Chronology Group have been incorporated into ASP training. In particular, the use of the standard template, inclusion of the adult’s views and wishes, and regular review of the chronology to ensure it informs the assessment and management of risk. We will continue to support staff in their practice on the use of chronologies through training, Council Officer Forum and guidance. Missing People The charity Missing People provides consultancy to tackle local professional challenges when responding to missing adults and children, and their families, in order to improve the support and services available. They are delivering a project in partnership with Scottish Government, to support the implementation of The National Missing Persons Framework in local areas across Scotland. East Lothian agreed to participate in this work in 2022. The consultants reviewed policies relating to missing people across services working with children and adults including Adult Protection, Child Protection, VAWG and the Mental Health pathways. They built on this in early 2023 with an event with operational managers from Adult Services and Child Services to map the responses to missing people. A Findings and Recommendations Report has been produced. Further work to develop a plan to support practice in this area and accessing on-line training available will be undertaken and we will share the learning and access to training with Midlothian. Learning and Practice Development Building on the positive feedback from our revised approach to Council Officer training, the ASP Lead Officer delivered our second course of eight modules (six taught sessions and two reflective sessions) between September 2022 and February 2023. Inputs were provided from Advocacy organisations and Council Legal Services. 13 Social Workers from East Lothian and Midlothian successfully completed this, which boosted the resources for ASP work. We opened this training to staff from Shetland and Scottish Borders, due to their low numbers of staff requiring trained, and provided three places. We commissioned an independent trainer to provide a two-day ASP Investigative Interviewing training course to 14 Council Officers in June 2022. Adult Protection themed Briefings In the year we introduced one-hour on-line Briefings to raise awareness of ASP topics. The choice of topics was informed by learning from Initial Case Reviews (Home Fire Safety Visits), self-evaluation activity (Advocacy Briefing, role of NHS Public Protection Team) and as a follow up to our ASP Day (Trading Standards). We delivered nine Briefings in the year: • In May 2022 and February 2023, a Briefing from Advocacy services in East Lothian and Midlothian, on behalf of all three advocacy providers operating in East Lothian and Midlothian; Page 308 of 348
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16 • In June 2022, Daphne Franks, whose mother was the victim of predatory marriage, delivered a Briefing on her experience and campaigning on the issue; • In October 2022, a Briefing from Trading Standards in Midlothian on their role in tackling scams and financial harm; • In November 2022, a Briefing from Trading Standards in East Lothian on their role in tackling scams and financial harm; • In December 2022 and January 2023, a Briefing from the ASP Lead Officer on the new Escalating Concerns Procedure; • In January 2023, a Briefing from the Scottish Fire and Rescue Service on Home Fire Safety Visits; and • In January 2023, the NHS Lothian Public Protection Team delivered a Briefing on their role in ASP. Feedback from staff who attended the above Briefings has been very positive, and we will continue to use this method of communication to raise awareness of key issues in ASP. National Adult Support and Protection Day – 20th February 2023 On 20th February 2023 we hosted an on-line learning event for 320 staff and volunteers from across East Lothian, Midlothian and Edinburgh. We know there was an increase in concerns about self-neglect during the pandemic when adults were being seen less in their home and were more isolated, with concerns only really coming to light once restrictions eased. This informed our focus for the event on self-neglect and hoarding to learn more about the particular challenges around managing these issues. This was supported by a short campaign video which we shared at the event. Professor Michael-Preston Shoot, an expert academic from the University of Bedfordshire, presented the evidence base for best practice around self-neglect, from research, safeguarding adult reviews and practice experience. His presentation was very engaging and informative, and we received positive feedback about the whole event. The keynote presentation was complemented by inputs from: • Our local Liaison Officer from the Scottish Fire and Rescue Service, who gave us an overview of their role in recognising and responding to hoarding; • A senior Social Worker, who provided an input on responding to the issue from an operational perspective; and • Our ASP Lead Officer, who outlined how ASP can help in cases of self-neglect and hoarding, and how to make a referral for support and protection. Quality Assurance Activity Audit of Inter-agency Referral Discussions (IRDs) reviewed by the IRD Overview Group IRD Overview Groups for East Lothian and Midlothian continued to review all adult IRDs on a monthly basis. Chaired by the ASP Lead Officer, participants include a Detective Inspector from the Police Public Protection Unit, Service Manager for Adult Support and Protection and the NHS Adult Support and Protection Advisor. The Group reviews the work undertaken to date and undertakes quality assurance activity of information sharing, risk management and decision making. The IRD Overview Group reviewed all adult IRDs on a monthly basis. Page 309 of 348
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17 Participants progressed any feedback or recommended action within their own agency as necessary. The ASP Lead Officer undertook audits of IRDs considered by each IRD Overview Group between October 2021 and May 2022, reporting to the P&QI Sub-group in May 2022. An IRD involves information sharing between Social Work, Police and Health, and discussion to assess risk and make decisions about next steps to protect the adult, including a decision to progress to a Case Conference. The audit found that it was appropriate to have held almost all of the IRDs undertaken. Strengths included information sharing. Areas for improvement were identified as SMART action planning and the need to take a more analytical approach to risk assessment. These areas of improvement will be progressed in the coming year through implementation of our Learning and Practice Development Strategy. Audits of the last 20 IRDs in each area up to March 2023 took place, reporting to the P&QI Sub-group in May 2023. These identified on-going strengths in that the IRDs were invariably appropriate to take place and information sharing was effective. Training is planned for Quarter 3, 2023-24 to build on improvements in SMART Interim Safety Planning. The role of Health in IRDs has been strengthened in East Lothian with dedicated Health Professionals now identified and trained to undertake the IRDs. Midlothian is also seeking to identify dedicated staff for IRDs. We benefit from a shared e-IRD platform (hosted by NHS Lothian) for recording IRDs and sharing information and will continue to review the effectiveness of our IRD processes and practice. Quality Assurance Activity – East Lothian The ASP Lead Officer and a Senior Practitioner in East Lothian completed an audit of various aspects of ASP work, including Duty to Inquires, Investigation Reports, Chronologies and Multi-Agency Risk Assessments. Almost all assessments were undertaken within agreed timescales. Investigation Reports positively recognised undue pressure, when present. Strengths in Chronologies included the use of neutral language, written with factual information, not opinion. Areas for development included consistently capturing the adult’s point of view in Chronologies. Multi-Agency Risk Assessments were completed on time, and with a logical flow of information. Areas for development included improving the use of SMART risk management plans and the detail of analysis. Overall, the audit agreed re-design of templates within the Social Work recording system to support stronger analysis of risk was required. It was agreed that the Types, Imminence, Likelihood and Severity of impact framework and SMART risk management planning from the ‘Analytical Risk Management in Adult Protection in East Lothian and Midlothian’ should be integrated into all ASP templates. Quality Assurance Activity – Midlothian In order to align with quality assurance work undertaken the previous year in East Lothian, there was an audit of Chronologies and the Multi-Agency Risk Assessment (completed when Page 310 of 348
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18 the decision to proceed to review APCC is made) in Midlothian. This was carried out on a multi-agency basis with representation from the ASP Lead Officer, Social Work, Health and Police. There were similar findings to the East Lothian audit. Strengths were that Chronologies were recorded using neutral language, written with information that is factual, not opinion. Areas for development included consistently capturing the adult’s point of view in Chronologies. Multi-Agency Risk Assessments were completed on time, were well structured and easy to follow. Areas for development included improving the use of SMART risk management plans and the amount of analysis in the assessment. After review of the use of the MARA in both East Lothian and Midlothian, it was concluded that there was duplication of recording in other templates, and the MARA template did not add value to risk management. EMPPC approved the retirement of this template in March 2023. Preparation for ASP Inspection East Lothian The ASP Lead Officer worked in partnership with senior operational managers to prepare the Position Statement in advance of the ASP Inspection in East Lothian, using the Care Inspectorate Framework. This built on self-evaluation activity that had been undertaken in the previous year, and provided a good opportunity to identify areas of strength as well as areas for improvement. Guidance and Procedures Adult Protection Procedures The Adult Support and Protection (Scotland) Act 2007 requires that there be a Code of Practice to guide multi-agency staff in ASP work. In September 2022 the ASP Lead Officer delivered a presentation to EMPPC on the key changes in the Code of Practice. In light of the refreshed Code of Practice published in July 2022, we drafted revised ASP procedures and commenced a period of consultation. Our revised Procedures will be implemented in the coming year. Escalating Concerns Procedure In June 2022, EMPPC approved a new Escalating Concerns Procedure. It was recognised that professionals are often dealing with long-term, entrenched behaviours and complex circumstances of adults. The Procedure was developed to provide guidance on managing cases relating to adults where existing Procedures and legislation are not appropriate or able to reduce levels of risk and where a multi-agency approach may be beneficial. It provides an operational risk management framework for adults (over the age of 16) who have been formally assessed as not meeting the three-point test (which is the criteria for formal, legislative risk management under Adult Support and Protection), but where the agency involved is still concerned that that the adult is at risk of harm. Page 311 of 348
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19 The Escalating Concerns Procedure can also be used when risk is unmanageable using existing ASP procedures, with the process being triggered by the Chair of an ASP Case Conference. The Escalating Concerns Procedure promotes multi-disciplinary responsibility for risk management, thereby removing responsibility from a single professional or agency. Nominated Service Managers in East Lothian and Midlothian assess the referral to determine if an Escalating Concerns Meeting is needed. The Procedure is aimed at providing an effective, co-ordinated multi-agency response to a ‘critical few’. Across both areas, the number of referrals was less than ten, and there were meetings for three adults. In all three meetings, senior managers were able to consider extra-ordinary service responses to address risk. It is early days in terms of assessing the effectiveness of the Escalating Concerns Procedure, and impact on the adults whose issues are addressed through this, and we will therefore review its use after a year of implementation. Large Scale Investigations A Large Scale Investigation (LSI) is a multi-agency response to circumstances where there is concern about an adult, or adults who may be experiencing harm or are at risk of harm. The ASP Code of Practice states a “Large-Scale Investigation (LSI) may be required where an adult who is a resident of a care home, supported accommodation, a NHS hospital ward or other facility, or receives services in their own home has been referred as at risk of harm and where investigation indicates that the risk of harm could be due to another resident, a member of staff or some failing or deficit in the management regime, or environment of the establishment of the service”. Following the Pan Lothian Large Scale Investigation Protocol, four LSIs in East Lothian and Midlothian commenced in relation to care homes for older adults. The issues considered within the LSIs included skills and training requirements, staffing levels and leadership. On conclusion of any LSI, EMPPC receives a report which includes reflections on the need for ongoing monitoring to oversee the implementation of improvement actions. In September 2022, EMPPC received a report from the ASP Lead Officer on a thematic analysis of risk management of case homes under LSIs (between 2018 and 2022). The report recommended that the Hull Early Indicators of Concern approach be adopted to promote preventative work to address the risk of harm in older people’s care homes. The ASP Lead Officer met with relevant staff in East Lothian and Midlothian to agree next steps for implementation which will involve the use of the Guide to collect and review concerns about a service from different sources. We will progress this in the coming year, and will also strengthen the approach to Multi-agency Strategy Meetings (as the Meeting to determine if there is a need for an LSI). In the year the Senior Practitioner for ASP in East Lothian delivered a Training for-Trainers event for Managers of Care Homes for Older Adults, to enable them to train staff in ASP (Level 1). Midlothian continued to deliver Level 1 training for staff in Care Homes for Older Adults. Page 312 of 348
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20 Learning Reviews We held one Consideration Meeting in relation to an adult following notification of a Learning Review under the Adult Support and Protection Learning Review Guidance. Two meetings took place and concluded that we did not require to proceed to a Learning Review, as we were able to sufficiently discuss the issues and learning arising from the case. Page 313 of 348
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21 Child Protection Annual data for year ending July 2022, as published in March 2023 Reviewing the Child Protection data published in March 2023 gives us an opportunity to review our data within the context of the national picture. We review data and performance information for both areas together using the National Child Protection Minimum Dataset, which is now well embedded in both areas. Inter-agency Referral Discussions In the year ending 31st July 2022, there were 353 IRDs in East Lothian and 584 in Midlothian. 3.08% of all IRDs across Scotland took place in East Lothian and 5.09% in Midlothian. Midlothian had the highest rate of IRDs per 1,000 children in Scotland, and East Lothian had the ninth highest rate. In the previous year, Midlothian had the third highest rate (27.7 per 1,000 children) and East Lothian had the fourth highest rate of IRDs (22.9 per 1,000 children). Nationally, the rate for the year was 12.6, a slight decrease from 12.8 the previous year. 584 353 0 200 400 600 800 1,000 1,200 City of Edinburgh Glasgow City Fife South Lanarkshire North Lanarkshire West Lothian Dundee City Midlothian Falkirk Highland North Ayrshire Renfrewshire Aberdeenshire Moray East Lothian Perth and Kinross East Ayrshire Dumfries and Galloway Angus West Dunbartonshire Scottish Borders Aberdeen City Clackmannanshire East Dunbartonshire South Ayrshire Inverclyde Argyll and Bute Shetland Islands Orkney Islands East Renfrewshire Stirling Na h-Eileanan Siar Number of IRDs (y/e 31/07/22) Page 314 of 348
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22 We have been conscious of higher rates of IRDs to other areas for some time now, through our discussions at our quarterly Child Protection Minimum Dataset Sub-group of the P&QI Sub-group, and at the P&QI Sub-group itself. We have recognised that we need to exercise some caution in making firm conclusions about this high rate and comparisons with other areas, as there is an established model of IRDs within the four Lothian Local Authority areas (through our shared multi-agency Child Protection Procedures), and IRDs are demand- driven. An additional local indicator of ‘the percentage of IRDs that meet EMPPC standards’ has been included in our Child Protection Minimum Dataset for some time now – the measurement of which is agreed through the IRD Overview Group (which operates fortnightly in each area with Police, NHS and Social Work, to support consistency of approach). In the year we have questioned the usefulness of this indicator and will continue to review how we measure effectiveness and ‘appropriateness’ of IRDs within the coming year. We have worked to strengthen our guidance on thresholds for IRDs, and to support IRD participants to reflect on practice. We can see a substantial decrease in the number of IRDs in the last quarter of this report’s reporting period for Midlothian, but will exercise caution in drawing conclusions from this. We will keep a watching brief on IRD rates and numbers over the coming year, and ensure that our practice remains aligned with local guidance. We have recognised that the model for IRDs within the National Guidance for Child Protection derived from the approach across the four Lothian Local Authority areas. 31.9 19 17.8 13.1 12.6 0 5 10 15 20 25 30 35 Midlothian Dundee City Moray Orkney Islands Shetland Islands Clackmannanshire West Lothian North Ayrshire East Lothian Falkirk East Ayrshire Perth and Kinross City of Edinburgh Fife Renfrewshire West Dunbartonshire Scotland South Lanarkshire Angus North Lanarkshire Dumfries and Galloway Highland Glasgow City Scottish Borders Inverclyde East Dunbartonshire Argyll and Bute South Ayrshire Aberdeenshire Aberdeen City Na h-Eileanan Siar East Renfrewshire Stirling Rate of IRDs per 1,000 children (y/e 31/07/22) Page 315 of 348
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23 Child Protection Register The table below illustrates the number and rate per 1,000 children on the Child Protection Register on 31st July 2022. The rate in East Lothian was slightly below the national rate. We have seen a substantial decrease in Midlothian in the past ten years, and a further reduction in the year prior to 31st July 2022. The greatest decrease of children on the Child Protection Register was Midlothian and Clackmannanshire. Number and rate per 1,000 children on the Child Protection Register at 31st July 2022 2012 number 2012 rate 2021 number 2021 rate 2022 number 2022 rate East Lothian 62 3.3 29 1.5 41 2.1 Midlothian 117 7.5 38 2.1 24 1.3 Scotland 2,698 2.9 2,119 2.3 2,031 2.2 117 71 94 124 116 91 107 97 97 82 81 73 88 91% 96% 97% 96% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100% 0 20 40 60 80 100 120 140 160 180 Nov-Jan 2019/20 Feb-Apr 2019/20 May-Jul 2019/20 Aug-Oct 2020/21 Nov-Jan 2020/21 Feb-Apr 2020/21 May-July 2020/21 Aug-Oct 2021/22 Nov-Jan 2021/22 Feb-Apr 2021/22 May-Jul 2022 Aug-Oct 2022 Nov-Jan 2022/23 % of IRDs that meet EMPPC standards Number of children subject to IRDs CP2: Number of children subject to IRD (LEFT AXIS) CP3: Number of IRDs that meet EMPPC standards CP3: % of IRDs that meet EMPPC standards (RIGHT AXIS) 135 116 148 122 113 124 108 114 164 161 145 142 82 94% 97% 97% 95% 100% 100% 100% 100% 100% 97% 99% 99% 100% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100% 0 20 40 60 80 100 120 140 160 180 Nov-Jan 2019/20 Feb-Apr 2020 May-Jul 2020 Aug-Oct 2020 Nov-Jan 2020/21 Feb-Apr 2021 May-Jul 2021 Aug-Oct 2021 Nov -Jan 2021/22 Feb -Apr 2022 May- Jul 2022 Aug-Oct 2022 Nov-Jan 2022/23 % of IRDs that meet EMPPC standards Number of children subject to IRDs CP2: Number of children subject to IRD (LEFT AXIS) CP3: % of IRDs that meet EMPPC standards (RIGHT AXIS) Page 316 of 348
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24 In both areas, the most common reasons in the year were parental drug misuse, domestic abuse, emotional abuse and parental mental health problems. Within Midlothian, the most common reasons in the year were domestic abuse, emotional abuse, neglect and parental mental health problems. This corresponds with the national picture where the most common concerns identified at Case Conferences of children registered during the year were: domestic abuse, neglect, parental substance misuse and parental mental health problems. Child Protection Case Conferences East Lothian held 75 Child Protection Case Conferences in the year ending 31st July 2022 and Midlothian 99. The number and rate in comparison to other local authorities and nationally are depicted in the two tables below. 99 75 0 50 100 150 200 250 300 350 400 450 500 Glasgow City South Lanarkshire Fife West Lothian North Ayrshire North Lanarkshire Renfrewshire Falkirk City of Edinburgh Aberdeen City Dundee City Highland East Ayrshire West Dunbartonshire Aberdeenshire Midlothian Angus Perth and Kinross Dumfries and Galloway East Dunbartonshire East Lothian Inverclyde Scottish Borders Moray Stirling South Ayrshire Argyll and Bute Clackmannanshire Na h-Eileanan Siar East Renfrewshire Orkney Islands Shetland Islands Number of Case Conferences (y/e 31/07/22) 5.4 4.5 3.8 0 2 4 6 8 10 12 North Ayrshire West… Falkirk Na h-Eileanan Siar Renfrewshire East Ayrshire West Lothian Inverclyde Dundee City South Lanarkshire Midlothian Angus Orkney Islands Aberdeen City Scotland Glasgow City Shetland Islands East… Clackmannanshire Fife Dumfries and… East Lothian Moray Stirling Perth and Kinross Highland North Lanarkshire Scottish Borders Argyll and Bute South Ayrshire Aberdeenshire City of Edinburgh East Renfrewshire Rate of Case Conferences per 1,000 children (y/e 31/07/22) Page 317 of 348
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25 Child Protection Registrations The tables below give an indication of activity around Child Protection registrations and de- registrations, and consequent impact on staff resources to ensure this area of protection work was prioritised. Business continuity arrangements existed in East Lothian for a period during the year due to staffing shortages. This meant that a small number of children who were on the Child Protection Register did not always have an allocated social worker for periods with their cases managed within the duty system. There was close oversight from a senior manager within Children’s Services to ensure that risk was appropriately managed for those children. We routinely review Child Protection Re-registrations within periods of three, six, twelve and twenty four months. We consider that a high number would potentially indicate risk is not being appropriately managed, particularly for the shorter time periods. Over the past year there has only been one case in Midlothian with a Re-registration within a 12 month period, for valid reasons due to domestic abuse, and there have been no cases in East Lothian within that time frame. We take assurance that having no children re-registered within the specified time periods to be positive. 12 20 21 5 27 11 6 23 18 22 9 11 14 47 47 47 34 38 35 29 37 42 44 40 25 31 10 20 21 18 23 14 12 15 15 19 13 26 8 0 10 20 30 40 50 60 70 80 Nov-Jan 2019/20 May-Jul 2020 Nov-Jan 2020/21 May-July 2021 Nov-Jan 2021/22 May-July 2022 Nov-Jan 2022/23 Number of Children Number of Registrations Number on Register Number of De-Registrations 17 16 26 16 28 25 14 17 7 17 17 25 15 54 50 49 35 45 37 38 32 30 33 24 47 41 34 20 27 30 18 33 13 23 9 14 26 2 21 0 10 20 30 40 50 60 Nov-Jan 2019/20 Feb-Apr 2020 May-Jul 2020 Aug-Oct 2020 Nov-Jan 2020/21 Feb-Apr 2021 May-Jul 2021 Aug-Oct 2021 Nov -Jan 2021/22 Feb -Apr 2022 May- Jul 2022 Aug-Oct 2022 Nov-Jan 2022/23 Number of Children Number of Registrations Number on Register Number of De-Registrations Page 318 of 348
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26 Supporting Practice Safe & Together East Lothian and Midlothian have been committed to embedding the Safe and Together approach since 2018. The Safe & Together™ Model is an internationally recognised suite of tools and interventions designed to help child and adult professionals become domestic violence-informed. The model has three practice principles and five critical components to guide assessment, analysis and planning. Supporting and embedding Safe & Together through core and supervisor training and supporting the work of the East Lothian and Midlothian implementation groups continue to be an EMPPC priority. This is led by the Child Protection Lead Officer, however, we very much recognise the intersectionality of this work across the Child Protection, Adult Support and Protection and Violence Against Woman and Girls agendas. The implementation groups in both Midlothian and East Lothian are well established, have multi-agency representation, are making progress and are both linked with the Improvement Service and national forum for Safe & Together. Midlothian undertook the Domestic Abuse-Informed Systems and Practice Self-Assessment process which they found beneficial in supporting and enhancing local implementation. The findings were positive, identifying that effective processes were in place to assess the wide-ranging impact of coercive control on children, with effective multi-agency leadership in place to support system change. East Lothian also plan to undertake this self-assessment within the coming year. In light of the pandemic, the Safe &Together Institute developed a Virtual CORE and a Supervisor programme which cover the same material as the in-person programmes. Videos of live training which include delivery by Safe & Together Model creator, David Mandel. The CORE training includes the same pre and post-tests. This was the agreed method of training throughout the pandemic and has continued in light of challenges around identifying a local ‘in-house’ accredited trainer. Training continues to be funded by the ‘Delivering Equally Safe Fund’. An annual report on Safe & Together is prepared for and considered by our L&PD Sub- Group. In the year 31 practitioners across East Lothian, Midlothian and Third Sector completed the on-line Core Practice Training. This number is well below the target of 65, which is similar to last year and continues to be associated with staffing issues (including vacancies and staff sickness), staff capacity in both areas and an over-optimistic assessment of the number of staff that would be available to undertake the training. Local Learning and Development leads delivered a ‘blended approach’ course (where the on-line material was accessed as a group with the support of a facilitator). This approach was well received by colleagues who fed back: • “I liked being able to discuss the content within the group and this made me understand how to use the approach in practice” • “The course was really helpful to think about supporting people where domestic abuse is a concern” Page 319 of 348
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27 • “Wouldn’t have been able to do this myself, my learning style doesn’t suit solo learning” • “Learnt a lot more from group discussion and mix of professionals etc as I would not have been able to focus for the full 4 days” • “Sharing ideas and hearing about others experiences was helpful” Despite the challenges associated with completing the on-line training, discussions with staff within various forums, evaluation and audit activity evidence that training is having a positive impact on practice - both the four day CORE and Supervisors Training. There is more evidence of work with children and young people in relation to the impact of domestic abuse/recovery from trauma, use of mapping and holding the perpetrator to account within assessment and planning. Marac chairs feedback that they continue to see an increase in the use of Safe & Together tools and language within assessments and discussions. The screening tool is embedded in duty/intake teams within Children’s Services in both East Lothian and Midlothian. Midlothian continue to implement the specific practice standards to promote the use of the approach as well as making monthly case consultations available to all agencies to discuss complex cases. Both areas have a Safe & Together ‘Champion’ to support implementation. Midlothian’s Your Chance to Change (voluntary domestic abuse perpetrator programme) has identified that staff are feeling more confident in holding men accountable for any abusive behaviour and there is evidence of good collaboration between Justice and Children’s Services staff to address risk and provide support to women survivors of domestic abuse. Work to increase understanding of and responses to Neglect EMPPC is keen to ensure staff are equipped to understand and respond to neglect. This has been influenced by local and national data and research, actions highlighted from Midlothian’s Joint Inspection Children’s Services Plan, learning from local and national Significant Case Reviews/Learning Reviews as well as ensuring practice is aligned to the ambitions of the National Guidance for Child Protection in Scotland 2021 in relation to prevention and early intervention. A multi-agency Neglect working group (consisting of professionals from Health, Education, Social Work, Police, SCRA and Third Sector) progressed its plan throughout the year. The aim of this work was to develop our local approach to identifying and responding to neglect, through the provision of a toolkit, guidance for staff and delivering learning and development sessions. During the year we agreed to use the City of Edinburgh Neglect Toolkit to support consistency of practice, and gained permission from their Child Protection Committee in December 2022. Police Scotland and NHS Lothian are already aware of and using this approach. The Neglect Toolkit was piloted using small tests of change with families across East Lothian and Midlothian, with evidence of effective collaboration and multi-agency working. A multi-agency staff survey was undertaken in December 2022 to provide a baseline of current knowledge and understanding of neglect, in order to inform the local implementation plan. This survey was targeted towards staff who specifically work with or deliver services to children and young people up to the age of 18, and their families. 188 staff from across Health, Education, Social Work, Police and Third Sector responded. Themes included: Page 320 of 348
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28 • Thresholds between different services – how to respond and support the family when concerns are raised by services but are not assessed as Child Protection; • Speaking about neglect with families highlighted challenges for staff around not wanting to damage relationships, not wanting to be seen as judgemental, feeling the word neglect can be emotive and provoke disengagement from families; and • Staff have a good understanding about neglect but lack confidence or can feel uncomfortable in addressing neglect directly with families. We promoted the CELCIS ‘Learning about Neglect Series’ across all services, to raise awareness and support learning. To support the launch of the Neglect Toolkit, we commissioned an external trainer to deliver two Briefings to 185 staff, and have developed a workshop approach to support understanding of how to use the toolkit in practice. This work will continue in the coming year. Harmful Sexual Behaviour work with NSPCC East Lothian and Midlothian engaged in support from NSPCC (funded by the Scottish Government) to undertake a Harmful Sexual Behaviour Framework Audit. The aim of this framework was to develop and improve multi-agency responses to children displaying harmful sexual behaviour (HSB) in order to provide a coordinated, systematic and evidence- based approach to recognising and responding to the risks and needs of this vulnerable group. There was a good appetite for this work from operational staff across services. Strategic leads for all services were identified in each area (Social Work, Police, Health, Education and Third Sector) and had a role in ensuring ‘buy-in’ from their service and promote engagement. A readiness questionnaire was completed by both local authorities to help inform the process. An information session and a launch of the framework survey took place to support engagement in the process. The audit survey was completed between December 2022 and February 2023, requiring to be extended in light of staff capacity issues. Engagement in the audit work was generally positive across all services, which supported analysis of the survey, completion of a findings report and action planning to commence. Validation meetings took place with the key representatives and NSPCC project workers in both areas to support analysis of the findings and agree final scores. We have seen a significant increase in children experiencing and displaying HSB across both local authorities. We have seen a number of benefits from engaging in this work. There have been strengthened multi-agency discussions in relation to HSB in terms of identification and response. There is an increase in awareness raising of HSB across all services and increased demand for places on our HSB Training course. The ongoing support and consultation from the NSPCC Implementation Manager throughout the audit process was helpful. The next phase of the project in the coming year will involve dissemination events in both areas and progressing an action plan. Page 321 of 348
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29 IRD Participants’ Workshop An in-person Multi-agency Learning and Development session for all IRD participants took place in November 2022. The event included 36 members of staff from Police Scotland, Children and Families Social Work in East Lothian and Midlothian and NHS Lothian. The session provided a good opportunity for key staff involved in Child Protection to strengthen their working relationships and peer support, and reflect on local IRD practice. The good practice within local IRDs was recognised and acknowledged. It provided an opportunity to reflect on local and national Child Protection statistics. The workshop covered the purpose and function of IRDs, thresholds and good practice. The need for self- care within Child Protection work was highlighted which promoted peer discussion around what is helpful. Feedback from the workshop was very positive, and we will further develop an IRD workshop approach in the coming year, using the themes arising from the IRD Oversight Group and discussion at the first workshop about what learning IRD participants would find useful. Learning from a Dissent Case The Dispute Resolution Protocol was instigated in July 2022. A consensus was not reached at a Child Protection Case Conference and an agency felt strongly that they did not agree with the decision not to register the child. A resolution meeting took place, where senior manager representatives from each agency attended. There was careful consideration and discussion of all the information and a unanimous decision was made to register the child. Suggestions to strengthen the Child Protection Plan were also fed back to the professionals involved in the meeting. A Multi-agency in-person reflective session was facilitated, with all the practitioners from each agency that had been involved in the Case Conference. This provided valuable learning to take back to agencies. A ‘7-minute briefing’ was developed to support learning from this process and was disseminated across all services. The briefing included information and practice prompts in relation to what is meant by dissent in the context of a Child Protection Case Conference, the importance of maintaining a focus on the child, the importance of preparing for the Case Conference, the value of constructive challenge and expressing professional opinion, the importance of professional curiosity and evidencing decision making. Guidance and Procedures Development of the Edinburgh, Lothians and Scottish Borders Child Protection Procedures During the year, a significant amount of work went into the development of our multi- agency procedures. With the support and input from an independent Social Work Consultant to work with us on their development, we worked in partnership with colleagues from Edinburgh, West Lothian and the Scottish Borders to develop draft Procedures. These Procedures underwent a period of consultation in February 2023. We held two Briefings to introduce the consultation and provide an overview of key changes, which were attended Page 322 of 348
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30 by 185 staff from East Lothian and Midlothian. Further work to bring these to a final conclusion continues, and we will implement these over the coming year. Learning Reviews In the year we concluded a Significant Case Review (under the previous Significant Case Review process) and developed a plan of improvement actions. Our CSOG has decided not to publish this, to ensure protection of privacy of the child involved, but local learning will be progressed via the action plan. In the year we held meetings to consider the need for a Learning Review for three cases and agreed to progress to a Child Protection Learning Review for each. We will progress these in the coming year, maintaining a proportionate approach in line with the principles in the National guidance for child protection committees undertaking learning reviews. We will use the learning and experience from these cases to develop our local Learning Reviews Guidance and resources, based on the national guidance. We have identified resource challenges for Learning Reviews and will seek to create a pool of local Chairs and Reviewers in the coming year, with training and skills development. We recognise that this is a national issue and we will engage in discussions via CPC Scotland to advocate for national support for this work. Quality Assurance Activity File Audit exploring conversion rates from Initial Child Protection Case Conference to Child Protection Registration - Midlothian Analysis of the Child Protection Minimum Data Set highlighted conversion rates in Midlothian decreased for two consecutive quarters. An audit was completed by the Child Protection Lead Officer and NHS Public Protection Clinical Nurse Manager to explore the circumstances of eight children from three families cases referred to a Child Protection Case Conference and where the child’s name was not placed on the Child Protection Register. The findings highlighted strengths within the early multi-agency sharing of information within the IRD process, however, it was assessed that Registration could have been considered further for all but one case. General themes outlined the need for ensuring the child’s voice is heard and considered within the assessment and planning process, limited evidence of SMART plans, more effective use of chronologies, further rationale to evidence decision making and limited evidence of professional curiosity and triangulating information. File Audit exploring Child Sexual Exploitation referrals to Children and Families Social Work – East Lothian Our review of the local Child Protection Minimum Dataset identified a need to focus on Child Sexual Exploitation (CSE) due to very low numbers of cases in East Lothian and Midlothian. A multi-agency audit was undertaken by the Detective Inspector, Police Public Protection Unit, Education Support Officer - Child and Public Protection, East Lothian and Page 323 of 348
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31 the Child Protection Lead Officer. It was assessed that in five out of the nine cases, a CSE Strategy Meeting should have been considered. Themes included the following: • Further analysis of information would have highlighted the risk factors and vulnerabilities; • More detailed information from Education would have helped to inform the assessment further in several of the cases; • The challenges of responding to incidents of on-line Harmful Sexual Behaviour; • The need for further multi-agency ownership throughout assessment and planning; and • Evidence of the voice of the child was not clear at times. In the coming year we will review our local guidance on CSE and provide learning and development opportunities, to raise awareness of the issues and response to children and young people at risk of CSE. IRD Themes The IRD Oversight Group continues to take place fortnightly to provide quality assurance and data collection in relation to decisions made as part of IRD. East Lothian and Midlothian Children and Families Senior Managers use a template to record the discussion and collate the information. The template focuses the multi-agency discussion to consider, clarity on the reason for IRD, any updates in relation to planning, previous IRDs in the last 12 months, whether it meets the standards (EMPPC CP Interim Safety Plan Guidance) and whether it meets the Threshold for IRD (Child Protection Inter-agency Referral Discussion Threshold and Outcome Guidance) as well as noting any learning or further action that is required to reduce risk. Themes identified throughout the year highlighted a number of strengths in practice in relation to IRD practice. Through our IRD processes in both areas, there are effective multi- agency relationships, timely sharing of relevant and proportionate information and co- ordination. The rationale for decision-making was identified as clear, with appropriate use of the Safe & Together approach, professional curiosity and robust interim safety plans. Areas for further learning and development included the management of repeat IRDs, recording within the IRD process and ensuring that the voice of the child is sought and evidenced throughout the process Learning and development - Child Protection Themed Briefings Launch of the Scottish Child Interview Model Briefing This was an opportunity for staff across all services to hear about the new Scottish Child Interview Model which was rolled out across East Lothian, Midlothian and Scottish Borders from May 2022. There was an emphasis on highlighting what this means for other professionals around the child and an opportunity to disseminate the associated resources developed to support multi-agency understanding of the approach (‘7-minute briefing’, glossary and flowchart). Page 324 of 348
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32 Each and Every Child: It is time for change ‘Introduction to Framing and Framing Care Experience’ Ensuring the voice of the child is heard is a central part of assessment, intervention and planning. This Briefing was delivered by Each and Every Child and was an opportunity for staff to gain an introduction to Framing and how our use of language matters when we talk about children and their experiences, how Framing can contribute to a positive shift in public attitudes, and how staff can make the recommendations of the Promise real in day- to-day work. Child Protection Consultation Briefings 185 staff from services across East Lothian and Midlothian attended two Briefings which were delivered to support the consultation on the new draft local Edinburgh, Lothians and Scottish Borders Child Protection Procedures. They included an overview of the National Child Protection Guidance and key changes, structure and scope of the new local procedures as well as highlighting what they will mean in practice. Page 325 of 348
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33 Violence Against Women and Girls (VAWG) Data and Performance Information Police Domestic Abuse Investigation Unit The Police Domestic Abuse Investigation Unit continues to target pro-actively domestic abuse perpetrators through various investigative strategies. This includes enforcement of domestic bail conditions to identify and arrest those in breach of Court issued bail conditions, wider pro-active investigations into historical perpetrator abuse through identification of previous partners and potential offending and multi-agency partnership working to address and mitigate risk to vulnerable victims and their families. Both East Lothian and Midlothian recorded the same change in terms of domestic abuse incident numbers, with East Lothian reducing by 60 incidents and Midlothian by 31 incidents in comparison to the previous year. Common assault is the most common type of crime recorded as a result of a domestic incident in both local authority areas overall. The number of offences recorded under Section 1 of the Domestic Abuse (Scotland) Act 2018 in East Lothian and Midlothian combined more than doubled from 8 in 2021/22 to 19 in 2022/23, which suggests increased awareness in its provisions. The Domestic Abuse Referral Pathway (DARP) operates on the basis of consent to referral to a specialist service when Police attend a domestic abuse incident. This is always offered by Police to victims. There was a decrease of 19 referrals in East Lothian and an increase of eight referrals in Midlothian from the previous year. EMPPO previously co-ordinated the DARP and hosted the Domestic Abuse Service for women survivors at high risk from domestic abuse. During this year the high risk service was relocated within Women’s Aid East and Midlothian (WAEML) and renamed the 1209 1169 1158 1127 700 750 800 850 900 950 1000 1050 1100 1150 1200 1250 1300 2016/17 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23 Number of incidents of domestic abuse reported by Police East Lothian Midlothian Page 326 of 348
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34 Domestic Abuse Advocacy Service (DAAS). DAAS continues to support women survivors at high risk referred through the Pathway or Marac or directly to WAEML. The DARP also changed and is now co-ordinated by Police. Applications to the Disclosure Scheme for Domestic Abuse Scotland (DSDAS) continue to rise for both aspects. The ‘Right to Ask’ allows concerned persons to apply for information regarding an individual’s abusive past whether that individual is a new partner or the partner of a family member or friend. The ‘Power to Tell’ allows the Police to disclose relevant information about an individual’s abusive past to any new identified partners, involvement in Police attended incidents or through contact with various partner agencies. Relevant information is then disclosed to individuals to allow them to make informed decisions regarding their personal safety. In East Lothian, during the year from 1st April 2022 to 31st March 2023 there were 56 applications. This yearly figure is a 27% increase on the same period in 2021/2022 (44). In 244 225 208 216 0 50 100 150 200 250 300 350 400 2016/17 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23 Number of victims referred to Domestic Abuse Referral Pathway East Lothian Midlothian 20.18 19.25 17.96 19.17 0.00 5.00 10.00 15.00 20.00 25.00 30.00 35.00 2016/17 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23 Rate of conversion from incidents recorded by Police to referrals to Domestic Abuse Referral Pathway East Lothian Midlothian Page 327 of 348
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35 Midlothian, during the year from 1st April 2022 to 31st March 2023 there were 89 applications. This yearly figure is a 39% increase on the same period in 2021/2022 (64). The increased use of DSDAS in each area highlights the ongoing success of pro-active promotion of the scheme through our EMPPC Briefings and Police social media messaging and showing our commitment to educating on this and all forms of domestic abuse. MARAC A Multi-agency Risk Assessment Conference (MARACs) is a local meeting where representatives from statutory and non-statutory agencies meet to discuss individuals at high risk of serious harm or murder as a result of domestic abuse. The meeting provides a safe environment for agencies to share relevant and proportionate information about current risk, after which the Chair will summarise risks and ask agencies to volunteer actions to reduce risk and increase safety. The primary focus is to safeguard the adult victim, however links with other agencies will be made to safeguard children and manage the behaviour of the perpetrator. All local authorities in Scotland hold Maracs on a non- statutory basis. Page 328 of 348
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36 In East Lothian, 106 victims were referred to Marac with 139 children involved; 73 of the cases had at least one child involved. There was a decrease of 17 cases referred from the previous year. There were 40% fewer cases referred than the SafeLives recommendation of 40 per 10,000 adult female population. Taking account of repeat referrals there were 93 individual victims of which 95.3% were females and 4.7% were males. In Midlothian, 137 victims were referred to Marac, with 229 children involved; 101 cases had at least one child involved. There was an increase of 22 cases referred from the previous year. There were 6% fewer cases than the SafeLives recommendation of 40 per 10,000 adult female population. Taking account of repeat referrals there were 117 individual victims of which 98.5% were female and 1.5% were male. The rate of Marac actions completed within the three week timescale has significantly increased in comparison to the previous year at 88.8% in East Lothian (an increase from 82.8%) and 82.9% in Midlothian (up from 77.1%). It is likely that additional Maracs particularly over the summer period have a negative impact on reporting of actions. 84.6 68.9 73.7 84.3 30.0 40.0 50.0 60.0 70.0 80.0 90.0 2018-19 2019-20 2020-21 2021-22 2022-23 % of Marac cases involving children East Lothian Midlothian 29.7 27.0 27.8 28.5 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0 2015-16 2016-17 2017-18 2018-19 2019-20 2020-21 2021-22 % of repeat cases discussed at Marac East Lothian Midlothian Lower expected Upper expected Page 329 of 348
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37 There has been no significant change in the percentage of repeat cases at Marac from the previous year. East Lothian was slightly below the SafeLives recommended range of 28% to 40% at 25.5% and Midlothian was within range and just above the lower control limit at 29.9%. MATAC MATAC (Multi-Agency Tasking and Co-ordination) is a Police led initiative to identify and manage the most harmful, repeat domestic abuse perpetrators. We have well-established local partnership arrangements for managing this process. In East Lothian there were five referrals in the year, an increase of one from the previous year. In Midlothian there were no referrals to MATAC in the year and none the previous year. There is work underway within the Police to look at the criteria for referral to MATAC and seek to increase the number of referrals, particularly given the increase in referrals to Marac. Women’s Aid East and Midlothian (WAEML) services This year we have expanded reporting on our local domestic abuse services for women, children and young people, which are primarily provided by Women’s Aid East and Midlothian, as shown below. WAEML data East Lothian Midlothian Number of women supported 371 401 Number of new referrals from women 271 266 Number of women referred 222 226 Number of children supported 119 117 Weekly average number of women waiting for an outreach service in each quarter Q1 42 Q2 56 Q3 60 Q4 50 Q1 64 Q2 59 Q3 61 Q4 53 Weekly average number of children waiting for an outreach service in each quarter Q1 31 Q2 27 Q3 30 Q4 30 Q1 27 Q2 32 Q3 35 Q4 32 Average number of days women were waiting for an outreach service in each quarter Q1 63 Q2 41 Q3 54 Q4 55 Q1 110 Q2 51 Q354 Q4 55 Average number of days children were waiting for an outreach service Q1 69 Q2 62 Q3 59 Q4 59 Q1 90 Q2 75 Q3 59 Q4 59 Number of women supported by the Domestic Abuse Advocacy Service (DAAS) Oct-March 27 28 Page 330 of 348
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38 Women’s most common support needs identified Mental health & wellbeing Safety Housing Financial Support A key concern for us has been to monitor demand and reduce the waiting lists and waiting times for support for women and their children, which had been accumulated due to the impact of the pandemic. All service users on the waiting list received ad hoc/triage support a minimum of every 10 days which includes risk assessment so that those at high risk are prioritised for support. Funding has been levered in to increase staff capacity and retention in the outreach services and the re-establishment of the high risk service from October 2022 has begun to have a positive impact. Sexual crimes The number of sexual crimes recorded by Police is not a count of victim or perpetrator – could involve multiple offences relating to the same victim or perpetrator. It also does not provide a breakdown by type or by historical/recent offences. The reported figures for 2022/23 are provisional and will be revised if necessary following their Official Statistics publication later in the year. In East Lothian, there has been a significant reduction in the number of sexual crimes reported from the previous year. Data over the previous five years shows that 2021/22 was an outlier in terms of volume, and therefore the total for 2022/23 was a return to more average levels of recorded crime, below that of two years ago (2020/21). The trend of increasing numbers of non-contact sexual offending since the pandemic is apparent in East Lothian in 2022/23 in terms of Communicating Indecently and Threatening/Disclosure of Intimate Image offences. The volume of Sexual Exposure offences also increased during 270 206204 209 0 50 100 150 200 250 300 2016/17 2017/18 1018/19 2019/20 2020/21 2021/22 2022/23 Number of sexual crimes recorded by Police East Lothian Midlothian Page 331 of 348
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39 2022/23, primarily as a result of one repeat male offender who was charged with a number of other sexual crimes including voyeurism and sexual communication offences. There has been very little change to overall numbers in Midlothian in the past few years. In terms of trends, there is similar pattern to East Lothian, with the proportion of sexual crime attributable to the non-contact offence of Communicating Indecently doubling since pre- pandemic years. This has also been mirrored with regards to crimes of Threatening/Disclosing of an Intimate Image which increased during the pandemic and has remained at elevated levels. Edinburgh Rape Crisis Centre saw a significant rise in the number of referrals in East Lothian, and a slight increase in referrals for Midlothian. Increased staff capacity in both areas helped to reduce average waiting times for short term here and now sessions. At the end of the last quarter of 2021-22, survivors were waiting 16 weeks for a session but the average for the year in 2022-23 was six weeks. Similarly in Midlothian, the average waiting times reduced from 16 at the end of the last quarter to five weeks for a ‘Here and Now’ session. Waiting times for long term support were significantly longer, averaging to 12-16 weeks in both areas. The increase in referrals for East Lothian was directly proportional to increased engagement with the community and professionals in East Lothian including greater visibility in the community. ERCC also saw an increase in engagement with both their services generally as they were able to meet access costs for survivors particularly travel and child care costs. One of the outreach locations in East Lothian is able to offer child care on site and this has helped with survivor engagement. 51 101 74 77 0 20 40 60 80 100 2016/17 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23 Number of survivors of rape and sexual abuse referred to ERCC East Lothian Midlothian Page 332 of 348
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40 Perpetrators In East Lothian the increase from 97 to 116 is probably representative of the resumption in Court ‘business as normal’ post pandemic, as well as a continued focus within East Lothian Justice Social Work to pro-actively screen in men for perpetrator interventions. Similarly in Midlothian the increase from 45 to 86 is representative of the resumption in Court business. In addition, Midlothian Justice Service has introduced changes including: assessing all men convicted of domestic abuse offences for the Caledonian Men’s Programme, whether requested by the Court or not; when this is not possible Justice Social Workers are required to complete a ‘screening’ questionnaire for all men subject to a Court report for domestic abuse offence to consider his suitability for further assessment; and renewed promotion of Your Chance to Change which is the voluntary service for perpetrators of domestic abuse. Supporting Practice Marac is key to Public Protection VAWG activity. This year we have completed 72% of our Marac Improvement Plan actions (approved December 2021). The key actions achieved were: • Improved support for victims at high/very high risk from domestic abuse by relocating the specialist support service and appropriate funding within Women’s Aid East and Midlothian, including recruitment of three specialist staff; • Offered briefings on Equally Safe and Marac for key services and for the wider workforce; • Provided a Marac developmental session focusing on creative action planning facilitated by SafeLives which was very well attended by our Marac representatives; • Recruited two further Marac chairs to reach a pool of seven chairs. This is key to being able to cover all 26 planned Maracs and any additional ones required to meet demand. Most chairs are now participating in national Marac chairs meetings. This is testament to our shared commitment to Marac; • Agencies improved their internal processes in relation to Marac by completing our Marac agency form; this ensures staff are aware of their service’s role in Marac and supports effective preparation, participation and reporting actions within timescale 97 116 45 86 0 20 40 60 80 100 120 140 2018/19 2019/20 2020/21 2021/22 2022/23 Number of referrals to specialist perpetrator interventions (men) East Lothian Midlothian Page 333 of 348
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41 • Agencies improved their understanding of risk in relation to Marac with more of them undertaking our Domestic Abuse, Stalking and Honour Based Abuse risk assessment and safety planning training; • Re-established the Marac Steering Group for governance and leadership with further work underway to ensure continuity; and • Strengthened business capability with new automated Marac agendas and improved reporting through our specialist database. Equally Safe in Practice (ESiP) We are delighted to have become an early adopter of Equally Safe in Practice (ESiP). ESiP is a new national training framework designed to build the capacity of the workforce to understand the dynamics of violence against women and girls and the causal link with gender equality. ESiP is key to delivery of the Equally Safe national strategy at local level. Scottish Women’s Aid delivered a presentation on ESiP and some of our L&D Sub-group members tested out the three modules within the Level 1 part of the framework. Level 1 is aimed at the general workforce, with three modules on gender equality, domestic abuse and sexual abuse. Feedback was positive with an interest in taking this forward locally in the coming year. Our CSOG has agreed to implement Level 1 across both Councils and for us to explore the Level 6 part of the framework which is for Leaders. In addition, NHS Lothian and Fire Service colleagues are looking into introducing EiIP into their agencies. VAWG Themed Briefings This year we introduced online Briefings which have proved very popular and have quickly become embedded into our Learning and Development calendar. In VAWG our core programme of Briefings now include: • Understanding Marac provided by EMPPO; • The Disclosure Scheme for Domestic Abuse Scotland (DS DAS) provided by the Police; • Black and Minority Ethnic Women’s Experience of ‘Honour’ Based Abuse provided by Shakti Women’s Aid; and • Understanding the Impact of Rape and Sexual Violence provided by Edinburgh Rape Crisis Centre. This year we also laid the foundations for other less visible aspects of VAWG such as Commercial Sexual Exploitation in relation to poverty and human trafficking and the sex industry as well as transforming masculinities. We have recognised that Briefings are a bite-sized accessible way to reach a much wider audience including management from across the workforce and elected members and they help to raise awareness of wider issues with a cross policy approach. We have greatly expanded our distribution list for Briefings and Newsletters, which help to deliver our core message that ‘Public Protection is everyone’s responsibility’. Page 334 of 348
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42 Developments/improvements This year each Council made a commitment to developing their own Equally Safe Strategy and Plan, acknowledging the benefits of a holistic approach across all services within each Council area. It is recognised that gender equity is key to preventing and eradicating violence against women and girls, as well as ensuring services are in place for survivors and to challenge perpetrators. This year we worked with the Council leads and the Improvement Service on the approach and timetable. Midlothian’s Equally Safe Leadership group was formed with the first meeting held in April 2023. East Lothian put in place new governance arrangements locating Equally Safe as a sub-group of the Community Safety and Justice Partnership. This work will progress in the coming year. Our partnership VAWG Prevention Plan was completed and approved in principle by EMPPC. It was agreed to divide the Plan into three areas of responsibility: Public Protection, East Lothian and Midlothian, so that latter two could inform the Equally Safe developments described above. We developed a VAWG Service Gaps baseline document covering services for people of all ages and genders, funding, capacity and policy. The VAWG delivery group will monitor the status of VAWG Service Gaps every six months. This document will inform service pathways work which will be part of each local authority’s Equally Safe implementation. Our partnership project ‘Delivering Equally Safe in East Lothian and Midlothian: Embedding a gender-informed effective response to VAWG’ is funded through the Scottish Government’s Delivering Equally Safe Fund. Our project focuses on domestic abuse covering the high-risk Domestic Abuse Advocacy Service and Safe & Together virtual training in Core practice for staff (equivalent to four days) and for Supervisors (equivalent to two days). This year we were able to make use of an underspend to support an additional 1.5 outreach staff from Women’s Aid East and Midlothian seeking to reduce the waiting list for support. The Scottish Government has extended this funding until March 2025 in time for commencement of the refreshed national Equally Safe strategy from 1st April 2025. Sustainable funding models/approaches The East Lothian and Midlothian Health and Social Care Partnerships, with support from EMPPO, undertook a joint review of funding, commissioning and governance arrangements for local VAWG services on behalf of the Critical Services Oversight Group. This, along with the Service Gaps document, will also contribute to the Equally Safe strategies discussed above. ‘Honour’ Based Abuse (HBA) is one of the lesser understood aspects of VAWG. In previous years we ran training on HBA which had limited uptake. This year we focused on integrating HBA into existing training and information, for example, within the Introduction to VAWG and Domestic Abuse Risk Assessment and Safety Planning trainings, our Marac Briefings and Newsletters and widening our reach by running periodic HBA briefings which are well attended. We set up an HBA short life working group led by Shakti Women’s Aid and Edinburgh Rape Crisis to identify what else would assist; there is an intention to provide supporting information for staff such as guidance and a ‘7- minute briefing’. Page 335 of 348
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43 The Restorative Justice (RJ) Programme within Community Justice Scotland, was launched in May 2022, and is being piloted in our Sheriffdom. There has been a national discussion and concern about the appropriateness of RJ for cases where VAWG is involved. The VAWG Co- ordinator and members of the VAWG delivery group have been actively engaged in national forums on RJ and in relation to this concern as well as through our local RJ stakeholder group. The national lead for Restorative Justice and Thriving Survivors delivered a presentation to the VAWG Delivery Group on the Restorative Justice service for survivors of rape and sexual assault that is being piloted in Midlothian. The VAWG Delivery Group received regular updates on local activity including recently published local research on the voices of those who have caused harm and Restorative Justice. We will continue to review progress in the coming year through our VAWG Delivery Group. Your Vision: Support for Young Women in East Lothian was published in November 2022. Edinburgh Rape Crisis Centre (ERCC) and Women’s Aid East and Midlothian (WAEML) commissioned this research with East Lothian Health and Social Care Partnership funding, to understand how many young women and non-binary people in East Lothian have experienced abuse or harm in their own relationships, and how many have experienced sexual assault. It looks at where they go for support currently, if there are barriers to getting support, and what kind of support is needed. YWCA Scotland carried out the research alongside the Young Women’s Research Collective, made up ofeight local young women aged 16 – 25, who designed the project. The survey collected 110 complete responses. The results reported that 31% of respondents had been in a relationship with someone who was abusive or harmed them physically or emotionally, and 36% of survey respondents had experienced sexual assault. The research was launched at an on-line event during our 16 Days of Activism programme which 76 people attended and it has also been widely promoted. In line with the report findings ERCC and WAEML are adapting their services, and services connected to young people in our communities plan to undertake Zero Tolerance’s Under Pressure training to improve the experience for girls and young women. We are hopeful that other local services will evolve to better suit the needs of young women in the local community. Contributing to the consultation on national commissioning of funding We have remained active in the National VAW Network providing a local perspective on national Equally Safe actions and those of many other policy areas. A key focus this year has been on contributing to the Independent Review of Funding and Commissioning of Violence Against Women and Girls Services in Scotland, which reported its findings on 5th June 2023. The principal role of the review was to develop a more consistent, coherent, collective and stable funding model that will ensure high quality, accessible specialist services across Scotland for women, children and young people experiencing any form of violence against women and girls. We participated at different points throughout the process including a dedicated session with the Independent Chair and responding as a partnership to the public call for evidence. We share the Network’s work through the VAWG Delivery Group and members are regularly invited to contribute to national roundtable discussions and we bring key developments to the attention of into EMPPC. Page 336 of 348
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44 Contribution to co-working – Midlothian Local Outcome Improvement Plan (LOIP) We have worked closely with the Midlothian Community Justice Board and Working Group to take account of the experiences of victims and also to develop the approach to delivering Equally Safe Priority 42 linking with prevention and early intervention work. This collaboration is reflected in our 16 Days of Activism to end VAWG launch event which focused on bringing men and boys on board and included key inputs on transforming masculinities. It is also evident across the new Community Justice Outcome Improvement Plan 2023 which makes a commitment to integrating a gender analysis across all services as well as developing and delivering a Priority 4 Pathway. Guidance and Procedures We developed a Marac Information Sharing Protocol with support from our Information Governance Manager in East Lothian. This provides guidance for staff on key principles around information sharing, GDPR and data protection. We will bring this to conclusion in the coming year. Our Marac Operating Protocol was reviewed and updated in line with service changes and developments. Awareness raising/communications The 16 Days of Activism to end VAWG is a key campaign led by the VAWG Delivery Group within the VAWG Prevention Plan. For our 2022 Programme, our partners ran 24 events, reaching more than 1,300 people, and many more through our collective media campaign – this does not include other initiatives that took place in local services and communities. Our focus was to ‘bring men and boys on board to end VAWG’. Our launch event on Friday 25th November, entitled ‘What next? Time to get our men and boys involved’ was attended by 74 people across East Lothian and Midlothian – staff, volunteers, local Councillors – it was great to see so many people who used the 16 days background on the MS Teams call – a really powerful message to us all! 2 Equally Safe Strategy Priority 4: Men desist from all forms of violence against women and girls and perpetrators of such violence receive a robust and effective response. Objectives: Justice responses are robust, swift, consistent and coordinated. Men who carry out violence against women and girls are identified early and held to account by the criminal and civil justice system. Relevant links are made between the experience of women, children and young people in the criminal and civil system. Page 337 of 348
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45 MAPPA EMPPC’s local sub-group, EMMG, provides the opportunity for multi-agency partnership oversight of the arrangements for MAPPA. MAPPA brings together professionals from the Police, Social Work, Housing, Health and the Scottish Prison Service in Edinburgh, the Lothians and Scottish Borders. These agencies are known as the ‘responsible authorities’. While the arrangements are co-ordinated by a central unit based in Edinburgh, the practical management of offenders remains the responsibility of these agencies at local level. Within MAPPA there are three risk management levels: • Level 1 - routine risk management by the ‘responsible authority’ • Level 2 - Multi-agency risk management • Level 3 - Multi-agency Public Protection Panels. Individuals subject to MAPPA processes include those subject to Sex Offender Notification Requirements (SONR) and those considered to pose an ‘Other Risk of Serious Harm’, more informally referred to as MAPPA category 3 individuals. Through EMMG we reviewed performance reports for both area on a quarterly basis. This provides an overview of MAPPA performance with 51 indicators. The majority of these indicators are reported on a national basis. Within East Lothian the total number of sex offenders subject to MAPPA at quarter period end-date ranged from 60 to 75 in the year, with the majority living in the community. All were being managed at MAPPA Level 1 (ordinary Agency management, where the offender can be managed by the lead agency in consultation with other agencies involved). Through the performance oversight, we identified throughout the year that the multi-agency Public Protection arrangements for the management of registered Sex Offenders were functioning effectively and efficiently. Within Midlothian, the total number of sex offenders subject to MAPPA at quarter period end-date ranged from 52 to 55 in the year, with the majority living in the community. Almost all were being managed at MAPPA Level 1, with a very small number managed at Level 2 (where there is inter-agency management, planning and reviewing between Police and other agencies). Similarly to East Lothian, we identified throughout the year that the multi-agency Public Protection arrangements for the management of registered Sex Offenders were functioning effectively and efficiently. The oversight and governance of the effectiveness of multi-agency working arrangements within Midlothian continues to be reviewed on a quarterly basis through random selection of cases managed by Police and Justice Social Work. A programme of audit is in place, supported by the MAPPA Co-ordinator for Lothians and the Scottish Borders. It was agreed that there should be four Level 1 MAPPA case file audits, with each audit focusing on one Justice Social Work and one Police managed case from each local authority area. The Justice Social Work Managers for East Lothian and Midlothian Councils, Detective Inspector, Sex Offender Policing Unit, NHS Lothian MAPPA Liaison Officer and the MAPPA Co-ordinator undertake the audits. A report was considered by our EMMG in August 2022. Significant areas of strength around inter-agency working, were identified: Page 338 of 348
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46 • All cases contained very detailed offending histories and all relevant information was appropriately recorded; • The use of approved risk assessment tools is clearly evident and the review panel supported the overall assessment of risk in each case; • MAPPA risk formulations demonstrate a clear understanding of the risks and provide future scenarios for offending; and • There was good evidence of real time information sharing and decision making between Housing, Health, Adult and Children’s Services, Police and JSW. The Justice Service Managers who are representatives on our P&QI Sub-group delivered a presentation to the November 2022 meeting to support discussion on and understanding of MAPPA performance. This was useful in highlighting the context of this work, recognising that MAPPA and the Caledonian programme are proportionately a very small part of the work carried out by Justice Services. In the coming year, we will take steps to raise awareness of MAPPA and its processes, to provide assurance about the level of monitoring, management and oversight of this area of work. Learning and Development • We delivered 27 multi-agency training courses over 174 hours, seven more than last year and three more than 2020-21; • 689 staff, volunteers and carers from East Lothian and Midlothian attended training courses, which was an increase of 41.8% from the previous year; • We introduced on-line Briefings to provide additional learning and development opportunities in a bite-sized, accessible way; • We delivered 22 on-line Briefings and Learning Events, including a Launch Event for 16 days of activism in November 2022 and for Adult Support and Protection Day in February 2023; • 1214 staff, volunteers and carers from East Lothian and Midlothian attended our on- line learning events and Briefings over three quarters of the year; • We delivered Council Officer (ASP) training for 14 Social Workers and one Health Professional; • Three courses were delivered in-person – all other courses and learning events were delivered on-line; and • 54.3% (349 of 643) of attendees at training provided feedback, with almost all reporting that they had increased their knowledge as a result of attending. Page 339 of 348
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47 Training Courses (excludes Council Officer training) Time period Number of courses Change from last year Number of attendees Change from last year Quarter 1, Apr - Jun 7 4 189 131 Quarter 2, Jul - Sept 6 3 134 66 Quarter 3, Oct to Dec 8 1 208 = Quarter 4, Jan to Mar 6 1 158 2 Total 27 7 689 223 Briefings and Events Time period Number of Briefings/Events Number of attendees Quarter 1, Apr – Jun 4 Did not collate Quarter 2, Jul – Sept 3 88 Quarter 3, Oct to Dec 6 259 Quarter 4, Jan to Mar 9 867 (968 including Edinburgh staff) Total 22 1214 Social Work, 242, 38% Other Council Departments, 45, 7%NHS, 106, 16% Education, 94, 15% Police, 19, 3% 3rd Sector, 132, 20% Scottish Fire and Rescue Service, 5, 1% Attendance at Training by Agency (2022/23) Social Work Other Council Departments NHS Education Police 3rd Sector Scottish Fire and Rescue Service Page 340 of 348
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48 Course Number delivered Partners involved in delivery Child Protection Risk Assessment and Processes (Core training) 5 Education – East Lothian and Midlothian, Social Work – East Lothian and Midlothian, Scottish Children’s Reporter Administration, Public Protection Unit Police Scotland, NHS Lothian, Lead Officer, Public Protection Office Child Protection Refresher Training 1 Lead Officer, Public Protection Office, Education – East Lothian Improving our Practice on Violence Against Women (Core training) 4 Women’s Aid East and Midlothian, Public Protection Office Adult Support and Protection Roles and Responsibilities (Core training) 4 Public Protection Unit Police Scotland, Social Work – East Lothian and Midlothian, Scottish Fire and Rescue Service, NHS Lothian Public Protection is Everyone’s Responsibility (Core training) 5 Public Protection Office Trauma, Domestic Abuse and Children and Young People 1 Caledonian Service Assessing Risks and Referring to Marac 1 Women’s Aid East and Midlothian, Public Protection Office Black and Minority Ethnic Women’s Experiences of Gender Based Violence 1 Shakti Women’s Aid Harmful Sexual Behaviour 2 Community Safety and Justice, Midlothian Child Sexual Exploitation Awareness 2 Barnardo’s Children Affected by Parental Substance Use 1 MELDAP and Public Protection Office Training evaluation All courses were evaluated by way of an on-line survey sent to participants after each course. The questions in the on-line survey include a mix of quantitative measures and Page 341 of 348
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49 opportunities to provide comments about what attendees liked and what would be even better. Our Learning & Practice Development Sub-group reviewed the reports from each training evaluation. 54.3% of attendees completed the on-line survey after training. This was a reduction from the previous year. 96.3% of attendees reported an increase in their knowledge as a result of attending the training, and 94.8% reported they had enough information to put their learning into practice. This was a reduction from 60.5% who completed an on-line evaluation last year. We routinely receive positive feedback about the multi-agency involvement in training delivery and we thank our partners for their ongoing commitment to supporting the development of content for and delivery of our learning and development activities. Feedback from training “I really liked this training. It was a fab mix of interactive and learning info. It was varied and absorbing. I learned things that I did not know and I realise how important this area is to address and consider in my work. I loved having discussions in small groups as it afforded the first opportunity to network that I have done in two years with other agencies. All very well thought through” Adult Support and Protection Roles and Responsibilities (Level 2) Informative. Varied amount of information - hearing from other professionals & their experience was good. Highlighting the importance of collaborative working. Delivered at a level that everyone could understand Adult Support and Protection Roles and Responsibilities (Level 2) “It was detailed & thorough, explaining clearly the processes, procedures & responsibilities of personnel before, during & after initial CP referral. It was helpful to have representation/presentations from people across the sectors” Child Protection – Risk Assessment and Processes (Level 2) “The training offered a really good balance between information sharing and opportunities to discuss/collaborate with peers. The pace was good, and there was a clear link across all presenters which helped reinforce learning” Child Protection – Risk Assessment and Processes (Level 2) “Interactive, informative and evidence based. Paced well with breaks and over 2 days allowing time to reflect. Non judgemental” Understanding VAWG and Spotlight on Domestic Abuse (Level 1) “The content was very clear and concise , which made understanding of a very sensitive issue easier to process” Understanding VAWG and Spotlight on Domestic Abuse (Level 1) “I feel as though it provided a toolkit for safeguarding which I can use easily now if my offices safeguarding lead is unavailable. Going forward I will also be more vigilant in flagging clients potentially at risk to the relevant authority where I may not have considered these Page 342 of 348
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50 before, believing there was not enough 'evidence'” Public Protection is Everyone’s Responsibility (Level 1) “Break out groups gave interesting insights in to other workers concerns and thought processes” Public Protection is Everyone’s Responsibility (Level 1) Reflections on our training Detailed reports of feedback from training were reviewed at our L&PD Sub-group. We aimed to return to more in-person training in the year, but saw competing demands for training venues, and therefore offered only three courses on an in-person basis. Whilst some staff indicated they wished to return to in-person training, others indicated they welcomed the flexibility of being able to attend on-line. Going forward we will have a hybrid approach to training, whilst recognising that some courses may be more suited to being delivered on an in-person basis, and we will therefore keep the delivery methods under review via our L&PD Sub-group. EMPPC Newsletter We continued to develop our EMPPC Newsletter over the year, which we disseminate and publish on a quarterly basis – in the year, we published editions in May 2022, August 2022, November 2022 and February 2023. These are available on the EMPPC Website and are aimed at providing learning and reference materials, as well as information about the work of EMPPC and its Sub-groups. In each edition we include a Spotlight on a specific topic of common interest across all services. We recognise that one of the purposes of our Newsletter as a learning and development tool, and will seek to ensure it has a wide audience-reach and continues to be promoted through our various local networks. Page 343 of 348
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51 Looking forward We will see some changes in 2023-24 in the membership of EMPPC and its Sub-groups. For the first time we will have an Independent Chair of EMPPC as Keith Mackay steps into the role. We will hold a developmental session for EMPPC later in the year, and identify themes for continuous improvement in how we work together to deliver on our shared priorities for Public Protection. As the developmental work our Critical Services Oversight Group started in 2022-23 comes to conclusion, we will take forward an improvement plan with actions included in our Business Plan. We are introducing a Learning Review Sub-group, which will be a Sub-group of EMPPC. Keith Mackay, our Independent Chair will chair this group. The remit of this will be to: 1. Maintain an overview of the progress of Learning Reviews – to ensure timescales for completion are on track and consider if any escalation is needed to address any drift/delay; 2. Oversee the development of action plans; 3. Monitor action plans arising from any Learning Reviews; and 4. Ensure plans are progressed to disseminate learning from any learning reviews. Two of our current Sub-groups will have new Chairs – our VAWG Delivery Group will be chaired by DCI Steve Wood, Police Scotland, and our EMMG will be chaired by Lindsey Byrne, CSWO/Head of Children’s Services, East Lothian Council. Across all areas of our business, we will continue to develop our approach to performance improvement, through multi-agency quality assurance activity, use of data. We will take steps to gather and learn from the views of and feedback from the children, adults and families who come into contact with our key processes to manage risk and harm. We will also work with partners locally and nationally to see how we can improve how we understand and measure the impact of all that we do. Adult Support and Protection Priorities We will finalise and implement our revised Adult Support and Protection Procedures. Alongside this, we will introduce the Adult Support and Protection Minimum Dataset of performance indicators. We will develop and progress the improvement plan arising from the East Lothian Inspection. We will undertake multi-agency self-evaluation and engage in a joint inspection in Midlothian which will take place at some stage in the coming year. Child Protection We will finalise and implement our multi-agency Child Protection Procedures. We will introduce the second iteration of the Child Protection Minimum Dataset of performance indicators. We will continue to develop our approaches to harmful sexual behaviour and child sexual exploitation. We will undertake multi-agency self-evaluation and engage in a joint inspection in East Lothian which will take place at some stage in the coming year. Page 344 of 348
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52 Violence Against Women and Girls Priorities In the coming year, we will see each local authority area develop their own Equally Safe Strategy and Plan, to ensure that the four priorities of the national Equally Safe Strategy are progressed across all services. Consequently, we will revise our VAWG Delivery Group terms of reference to ensure there is alignment with the work with the two areas to support the development of their local Strategies. MAPPA We will ensure our Sub-group is well aligned to the Lothians and Borders MAPPA Operational Group and Strategic Oversight Group. Page 345 of 348
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Appendix 1 – Business Plan Priorities 53 What will we do (our high level aims) What we are working to achieve What difference will it make (outcome and impact) Continue to strengthen our leadership arrangements in Public Protection To have effective partnership working arrangements and shared responsibility for Public Protection We can demonstrate that children, young people and adults are safer and better protected from risk of harm: • Children, young people and adults receive the right support at the right time to prevent harm and reduce the impact of harm • Child and adult protection concerns are recognised and responded to in a trauma informed way (with compassion, care and protection) • We are meeting and improving our agreed performance standards in key processes and practice • Staff are competent and confident in recognising risk and harm and responding appropriately To have and communicate a shared vision for the delivery of Public Protection services across East Lothian and Midlothian To work with the planning partnership arrangements to identify issues and influence responses within local plans Provide and support the implementation of multi-agency procedures and guidance for staff working in Public Protection To lead and guide staff in their practice To promote a collaborative and integrated approach to reducing harm Continue to develop our performance framework and approach to quality improvement To ensure that we are collating and analysing the right type of information to support performance monitoring and continuous improvement Page 346 of 348
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Appendix 1 – Business Plan Priorities 54 What will we do (our high level aims) What we are working to achieve What difference will it make (outcome and impact) To ensure that we are influencing services to respond to emerging risks and trends To support the transfer of learning into practice Promote and support a learning culture by providing staff with multi-agency learning and development opportunities in Public Protection To promote and embed a culture of learning To support the workforce in East Lothian and Midlothian to become increasingly competent in their specific areas of responsibility and across all areas of Public Protection, through the provision of shared learning opportunities To support staff to build effective working relationships and shared understanding of roles and responsibilities What will we do (our high level aims) What we are working to achieve What difference will it make (outcome and impact) Page 347 of 348
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Appendix 1 – Business Plan Priorities 55 We will raise awareness of Public Protection through communications and engagement with staff and communities To ensure that our work is informed by the experiences and rights of children, young people and adults To ensure that our work is informed by the experiences of staff To ensure that staff across services know how to raise concerns about child and adult protection and access support To ensure that appropriate information about Public Protection is provided to the public, and that members of the public know how to raise concerns about Child and Adult Protection, and seek support Page 348 of 348